حسن رزمجو

To investigate the effect of smoking on corneal parameters, including Endothelial Cell Density, Central Corneal Thickness, Percent of Hexogonality, and Coefficient of Variation.

This study was a systematic review and meta-analysis of published articles until the end of February 2019. To do this, the first search was done for creditable medical databases such as PubMed, and ISI (Web of Science), using an article search strategy and keywords derived from MeSH, including cigarette, smoking, tobacco, and their derivatives and relevance. They were conducted with the keywords pachymetry and corneal thickness. All English and Persian related articles were extracted by two independent researchers and by a thorough review of the articles; the articles that met the inclusion criteria for the present meta-analysis were selected for analysis.

Initial search of 351 articles found that information of 8 studies was selected and entered into the present meta-analysis. The total number of participants was 588 in the cigarette smoking group and 602in the non-cigarette smoking group. The mean age of the two groups was 38.9 and 40.4 years, respectively, and 21% of the participants were female. Of the studies included in the present meta-analysis, all studies reported the information needed to analyze the CCT index. For CV, ECD, HEX, and AXIAL LENGTH indices 4, 4, 4, and 5 studies reported the information required for performing the meta-analysis, respectively. The results of the meta-analysis showed that smoking had no significant effect on any of the corneal parameters, including CCT, ECD, CV, AXIAL LENGTH, HEX (P=0.543, P=0.591, P=542, P= 0.231, P=0.584, respectively).

Smoking does not affect different parameters of the cornea. Due to the limited number of articles in this field, it is recommended to investigate the effect of cigarette smoking in more samples to compare the effect of cigarette smoking on high daily volume of corn.

Retinal vein occlusions are one of the most common form of retinal vascular disorders and could lead to vision loss due to macular edema, macular ischemia and sequelae from neovascularization. Anti-venous endothelial growth factor (anti-VEGF) treatment is the choice strategy of treatment for patients with macular edema secondary to central retinal vein occlusion (CRVO). There is an evidence of body with the controversies regarding increment of choroidal thickness in CRVO condition. The current study was designed to determine whether baseline subfoveal choroidal thickness may be an indicator for visual and anatomical outcome of bevacizumab in patients with CRVO macular edema.

This study was a prospective clinical cohort study that enrolled in 23 new cases of treatment-naïve central retinal vein occlusion (CRVO) from February to July 2017 who were visited in Feiz Eye Hospital, Isfahan, Iran. Patients received a single injection of bevacizumab and were followed for 30 days. Ratio of subfoveal choroidal thickness (SFCT) was measured using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). Ratio of SFCT of the CRVO eye to the fellow healthy eye (SFCT1/F) was taken as independent variable. Changes of best-corrected visual acuity (BCVA) in LogMAR (ΔBCVA, functional response) and secondary to baseline central macular thickness ratio (CMT2/1, anatomical response) in the CRVO eyes were taken for comparative and correlative analytics.

A total of 46 eyes from 23 patients with the mean age of 64.60±10.19 years were included in this study. Baseline SFCT was higher in CRVO eyes (251.91±46.09 µm) in comparison to the fellow eye (206.95±26.62, P<0.0001). Also central macular thickness in CRVO eyes were significantly higher in CRVO eyes in comparison with fellow eye (531.04±38.22 vs 303.30±33.59, respectively, P<0.05). SFCT1/F, correlated moderately with anatomical (CMT2/1) and strongly with functional response (ΔBCVA).

Bilateral evaluation of SFCT by EDI-OCT in all newly diagnosed CRVO cases is recommended to determine if there is a relative increase in choroidal thickness. This may help predict short-term response to anti-VEGF therapy.

In spite of numerous studies demonstrated efficacy and safety of photorefractive keratectomy (PRK) by cross cylinder and WF-guided methods، only limited studies are done in the field of advanced methods such as advanced personalized technique (APT). This study was performed to compare pre- and post-operation visual acuity and refractive errors in patients with over two diopter astigmatism treated by APT method.

This clinical trial study performed on 16 sequential patients (10 men and 6 women) referred to Sadra clinic of Isfahan، Iran، in the year of 2011. After complete ocular examination، for both eyes of each patient، PRK by APT method was done. Six months after surgery، abrometry was done for patients.

32 eyes of 16 patients with the mean age of 28. 8 ± 6. 9 year were involve in this study. Visual acuity of both eyes increased from 2. 72 ± 3. 13 to 7. 06 ± 3. 3. Myopia of both eyes changed from -2. 18 ± 2. 29 to 0. 26 ± 0. 41 and astigmatism decreased from 3. 54 ± 1. 03 to 0. 75 ± 0. 66. All changes were statistically meaningful (P < 0. 0001 for all).

PRK by APT method significantly increases visual acuity، corrected and non-corrected vision and decreases myopia and astigmatism. Despite، further studies with more patients and longtime follow-up is recommended.

Keratoconus is a progressive disease occurring in adolescence or early twenties. In an eye with keratoconus, the cornea thins and bulges out into an irregular cone shape. Although keratoconus may be seen in one eye, in 90% of cases, both eyes are damaged. Cross-linking is a novel, very chip, and rapid method to treat keratoconus. Since few studies have evaluated this method we assessed the improvement of keratoconus following cross-linking.

This clinical trial study was performed in Feiz Hospital during 2010-11. The target population was patients with keratoconus who were scheduled for cross-linking. Visual acuity was measured before and after the operation. The collected data was analyzed with SPSS20.

The mean ± SD of visual acuity was -2.66 ± 2.2 before the operation and -2.8 ± 4.7 after the operation (P = 0.65). While visual acuity was not changed in 29 patients (29%), it decreased in 43 cases (43%) and increased in 28 (28%).

According to the results of this study, cross-linking had no acceptable effects on visual acuity in cases of keratovonus. More studies are required to clarify the efficacy of this method in improving keratovonus.

To determine the outcomes of visual correction with femto-LASIK following PK.

In this prospective study, 34 eyes of 31 patient who had undergone thin – flap lasik due to high refractive error after corneal grafting were evaluated. After complete ocular examination and assessment of uncorrected and corrected distant visual acuity (UCVA and BCVA), the patients underwent femto-lasik using the Ziemer femto-LDV with 100 micron flap thickness.

After 3 to 19 (10.14±4.81) months of follow-up, mean UCVA increased from 1.5 Log MAR preoperatively (5/100) to 0.3 LogMAR (5/10) postoperatively (P<0.05). Mean BCVA also increased from 0.3 LogMAR (5/10) to 0.1 LogMAR (8/10) (P<0.05). Mean spherical equivalent changed from -6.98±3.87 to -2.18±2.69and mean of defocus equivalent also decreased from 10.32±3.74 preoperatively to 4.13±2.93 postoperatively (P<0.05 for both). No significant intraoperative and postoperative complications occurred.

Femto-LASIK surgery after penetrating keratoplasty is a successful procedure for correction of moderate to high refractive errors. It seems to be clinically safe, effective and predictable.

Refractive surgery is the most rapidly evolving issue in ophthalmology. In this study, we compared the effect of two phakic intraocular lenses, Artisan and Artiflex, in refractive surgery.

In a prospective clinical trial studyd 58 eyes of 29 patients with high myopia were treated by phakic intraocular lenses. Artiflex lens was used in 24 eyes and Artisan lens in 34 eyes. Patients were followed up for 6 months. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and refraction were assessed in both groups.

Artiflex lens had better visual outcomes; but the difference with Artisan lens was only significant in first two months of follow-up. After 6 months, both groups had similar visual outcomes. Although astigmatism was greater in Artisan group in first three months, refraction in both groups was stable after 6 months and the results were not significantly different between the groups. Adverse reaction was not noticed.

Artisan and Artiflex had similar long-term outcomes but refraction and vision establishment occur in a shorter period in Artiflex lenses.

There are different surgical methods for the treatment of patients with keratoconus. The aim of this study was to compare deep lamellar keratoplasty (DLK) and penetrating keratoplasty (PK) methods.

This clinical trial was performed between 2009 and 2011 on 30 Iranian patients. Subjects were recruited consecutively in Feiz hospital, Isfahan, Iran and were randomly entered two groups (each one including 15 cases) under the treatment of DLK or PK.

Two groups (DLK vs. PK) were matched in age (29.4 ± 2.3 vs. 30.9 ± 4.1, P = 0.61) and sex (P = 0.23). Best-corrected visual acuity (BCVA) was decreased significantly in both groups and no difference was found between the decline level between the groups (P = 0.142). Also, regarding improvement of refractive problems, no difference was observed in decline of spherical equivalent (P = 0.533) and astigmatism (P = 0.791). Mean time of suture removal was significantly (P < 0.001) lower in DLK group (6.20 ± 2.11 months) versus PK group (10.93 ± 2.40 months). No complications were observed during both procedures. However, after PK, four cases complicated with endothelial rejection and one with graft failure. Also, after DLK, one case with interface neovascularization and another with stromal rejection were observed.

Both methods are effective in reducing the refractive status of keratoconus patients and result in proper BCVA improvement. However, DLK seems to have more successfulness and fewer complications.

Ocular motor disturbances occur as the presenting or relapsing sign/symptom of multiple sclerosis (MS). In this study we sought to asses the frequency of isolated ocular motor nerves palsy in patients with in Isfahan, Iran.

Our study was a retrospective study on 3522 patients with definite MS (based on McDonald’s criteria), who had experienced isolated ocular motor nerves palsy as a presenting or relapsing sign. All of these patients were resident within Isfahan province until the end of July 2010 and they were registered in Isfahan MS society. Data were obtained retrospectively by analyzing patients’ regular follow-up records.

76 patients (2.15) had history of isolated ocular motor nerves palsy, in whom 32 cases (0.91%) and 44 cases (1.24%) had represented it “at the onset” and “during the course” of MS, respectively (P = 0.19). Abducens nerve palsy was seen in 56 patients (1.59%) and was the most common isolated ocular motor nerves palsy. The second prevailing palsy was pertaining to oculomotor nerve which was seen in 18 patients (0.51%). The least prevailing palsy was of Trochlear nerve that occurred in 2 patients (2.6%). Among 76 cases, only 30 had plaques in their brainstem MRI.

According to our current experience, the frequency of isolated ocular motor nerves palsy (2.15%) in MS is relatively low

To evaluate refractive, visual, topographic, and wavefront outcome of photorefractive keratectomy (PRK) for treatment of myopia and myopic astigmatism with two different excimer laser systems: Technolas 217z and Lasersight LSX excimer lasers.

183 eyes of 95 patients enrolled in this clinical trial. Patients underwent PRK in a Sadra refractive surgery center with Technolas or Lasersight system by a single surgeon between 2007 and 2011. For PRK we used Technolas 217z in one group and Lasersight LSX excimer laser in another group. Subjects examined before and 24 months after surgery evaluating vision, refraction, Orbscan topography, and Wavefront analysis. Data collected, analyzed with SPSS 16. We used Student t-test for statistical data analysis.

83 eyes were in the Lasersight group and 100 eyes in the Technolas group. Pre-op spherical equivalent refraction was not different in two groops. After surgery it was -0.93 ± 0.73 in Technolas and -0.19 ± 0.40 in Lasersight group, the difference was statistically significant (P < 0.001). Post-op difference vector of astigmatic correction was 0.44 ± 0.58 in Technolas and 0.41 ± 0.26 diopters in Lasersight group (P = 0.04). Post-op LogMAR Acuity was 0.015 ± 0.027 in Technolas and 0.0005 ± 0.005 in Lasersight group (P < 0.001). Post-op Q value of asphericity was 0.24 ± 0.33 in Technolas and 0.46 ± 0.37 in Lasersight group (P < 0.001).

Post-op spherical equivalent refractive outcome, best corrected distance visual acuity and satisfaction were better in Lasersight group. We did not find any difference regarding post-op wavefront analysis between groups.

Photorefractive keratectomy or PRK is a good way to correct mild, moderate and severe myopia and astigmatism. Because of several reports about the sight threatening of Hyperopic PRK, it’s effectiveness is less known. This study was done to characterize the refractive changes after excimer laser PRK for correction of hyperopia > 3 diopters and to assess refractive state and changes in astigmatism after 1year.

In an interventional study, thirty eyes of nineteen patients were participated. Their mean refractive error was +5.45 diopters and mean astigmatism was -1.42D. All of the patients were treated by Technolas 217-z excimer laser. Post operative SE (sphere equivalent), UNCVA (uncorrected visual acuity), BCVA (best corrected visual acuity) and all of the complications examined at 12 months later.

The mean post operative refraction was +1.00D (range-2.00 to +5.00), the mean SE was 0.55D and mean astigmatism was -0.95D (range -0.25 to-2.00D). Mean BCVA was unchanged or improved in 83.4% of cases (pre op log MAR = 0.10 and post op log MAR = 0.11) but five eyes (16.6%) lost 1 or 2 lines of snellen BCVA. In 46.6% refraction was within +/-1.00D and 80% was within +/-2.00 from target refraction. The grade corneal haze in eighteen eyes (66%) was 0 or 0.5 and in one eye was 3 and neither developed to grade 4.

Hyperopic PRK has a low predictability for high hyperopia but it is effective for low hyperopia. We do not recomended PRK in highly hyperopic-astigmatic eyes.

This study aimed to evaluate the changes of posterior corneal curvature after photorefractive keratectomy (PRK) in patient with myopia greater than 6 diopters.

The study was conducted on 107 eyes of 57 patients with the preoperative spherical equivalent refractive error of at least minus six diopters. Subjects underwent PRK for treatment of myopia or myopic astigmatism and were followed 4 months later to evaluate their refractive error. The posterior corneal curvature was evaluated by orbscan II topography preoperatively and 4 months after PRK.

The diameter of posterior corneal best-fitted sphere (BFS) in 3, 5, 7 and 10 millimeter zones before surgery was 6.089 ± 0.2666, 6.137± 0.253, 6.299 ± 0.268, and 6.506± 0.312 millimeters respectively and after surgery these values had changed to 5.673± 0.362, 5.809± 0.341, 6.056± 0.309, and 6.347± 0.334 millimeters respectively.

PRK for treatment of high myopia makes significant changes in the diameter of all measured zones of posterior cornea. The amount of alteration changed with regard to the selected zone, with the maximum effect in 3 and minimum effect in 10 millimeter zones.