فهرست مطالب dr. shiva mehravaran

Despite studies about anxiety in the older adult, the prevalence of anxiety in this age group is not exactly clear, which may be due to the use of tools and criteria that were not born for this age group. One of the instruments designed to assess anxiety in the elderly is the Geriatric Anxiety Inventory (GAI). The aim of this research was to analyze the psychometric properties of the Persian version of the Geriatric Anxiety Inventory (GAI-PV) and its short form (GAI-PV-SF) in a sample of older adults in Iran.

In this cross-sectional study, a sample of 150 community-dwelling and a psychogeriatric sample of 48 adults older than 60 years completed the GAI-PV and GAI-PV-SF, the anxiety sub-scale of the General Health Questionnaire (GHQ-28), the Geriatric Depression Scale (GDS-15), and the Structured Clinical Interview for DSM-IV (SCID-I). Different types of validity and reliability were evaluated for GAI-PV and GAI-PV-SF using SPSS and the LISREL software. 

Both the GAI-PV and GAI-PV-SF exhibited excellent internal consistency (over 80 %) and desirable concurrent validity against GHQ-28 and GDS-15. The optimal cutpoint score to detect current generalized anxiety disorder (GAD) was 10/11 and 13/14 for GAI-PV in the community-dwelling and psychogeriatric samples, respectively, and 3/4 for GAI-PV-SF in both study samples.  Good test-retest reliability (correlation coefficient: 0.96 and 0.88 for GAI-PV and GAI-PV-SF, respectively) and a single-factor structure were also demonstrated.

Sound psychometric properties of the GAI-PV in both subsamples suggest that the instrument could be used successfully as an accurate screening instrument in the elderly Iranian population.

PurposeTo investigate the short-term outcomes after intravitreal injection of ziv-aflibercept in the treatment of choroidal and retinal vascular diseases.
MethodsThirty-four eyes of 29 patients with age-related macular degeneration (AMD), diabetic retinopathy, and retinal vein occlusion (RVO) received a single dose intravitreal injection of 0.05 ml ziv-aflibercept (1.25 mg). Visual acuity, spectral domain optical coherence tomography (SD-OCT) activity, and possible side effects were assessed before and at 1 week and 1 month after the intervention.
ResultsAt 1 month after treatment, mean central macular thickness (CMT) significantly decreased from 531.09 μm to 339.5 μm (P ConclusionOur findings suggest that a single dose intravitreal injection of ziv-aflibercept may have acceptable relative safety and efficacy in the treatment of patients with intraocular vascular disease.
The trial was registered in the Iranian Registry of Clinical Trials (IRCT2015081723651N1).

The hyperimmunoglobulin E syndromes (HIESs) are very rare immunodeficiency syndromes with multisystem involvement, including immune system, skeleton, connective tissue, and dentition. HIES are characterized by the classic triad of high serum levels of immunoglobulin E (IgE), recurrent staphylococcal cold skin abscess, and recurrent pneumonia with pneumatocele formation. Most cases of HIES are sporadic although can be inherited as autosomal dominant and autosomal recessive traits. A fundamental immunologic defect in HIES is not clearly elucidated but abnormal neutrophil chemotaxis due to decreased production or secretion of interferon ? has main role in the immunopathogenesis of syndrome, also distorted Th 1/Th 2 cytokine profile toward a Th 2 bias contributes to the impaired cellular immunity and a specific pattern of infection susceptibility as well as atopic-allergic constitution of syndrome. The ophthalmic manifestations of this disorder include conjunctivitis, keratitis, spontaneous corneal perforation,recurrent giant chalazia, extensive xanthelasma, tumors of the eyelid, strabismus, and bilateral keratoconus. The diagnosis of HIES is inconclusive, dependent on the evolution of a constellation of complex multisystemic symptoms and signs which develop over the years. Until time, no treatment modality is curative for basic defect in HIES, in terms of cytokines/chemokines derangement. Of note, bone marrow transplant and a monoclonal anti-IgE (omalizumab) are hoped to be successful treatment in future.

To determine the corneal elevation values and keratoconus indices in the 40- to 64-year-old population and their changes with aging.
The 6311 invitees of this study were selected through random cluster sampling, and 5190 of them participated in the study (response rate ¼ 82.2%). Here, we analyzed results of Pentacam acquisitions in 4148 respondents. Cases of keratoconus and forme fruste keratoconus (FFKC) were determined using topography and clinical data. Studied variables included keratoconus indices, central corneal thickness readings, maximum elevations on the anterior and posterior surfaces, and elevation values at the thinnest point, anterior steepest point, and posterior steepest point in healthy, FFKC, and keratoconus groups.
In all subjects, the mean maximum elevations were 6.80 ± 5.0 mm and 16.60 ± 7.7 mm on the anterior and posterior corneal surfaces, respectively. Maximum elevation values on the anterior and posterior corneal surfaces showed significant correlations in the keratoconus, FFKC, and healthy groups (P Anterior elevation values slightly increase with age, and keratoconus indices change as well. Elevation readings and keratoconus indices in the keratoconus group and FFKC cases are higher than the healthy corneas although their values could be compared with other studies on younger participants.

To determine inter-device agreement for central corneal thickness (CCT) measurement among ultrasound pachymetry, rotating Scheimpflug imaging (Pentacam, Oculus, Wetzlar, Germany), and scanning slit corneal topography (Orbscan II, Bausch & Lomb, Rochester, NY, USA) in highly myopic eyes before and after photorefractive keratectomy (PRK). This prospective comparative study included 61 eyes of 32 patients with high myopia who underwent PRK. Six month postoperative CCT values were compared to preoperative values in 27 patients (51 eyes) who completed the follow up period. To determine the level of agreement, Pentacam and Orbscan II readings were compared to ultrasonic pachymetry measurements as the gold standard method. Mean CCT measurements with ultrasound, Pentacam, and Orbscan II before PRK were 557 micrometers, 556 micrometers, and 564 micrometers, respectively; and 451 micrometers, 447 micrometers, and 438 micrometers 6 months after surgery in the same order. Preoperatively, the 95% limits of agreement (LoA) with ultrasound measurements were -20 micrometers to 17 micrometers for Pentacam and -21 micrometers to 33 micrometers for Orbscan II. Six months postoperatively, the 95% LoA were -30 micrometers to 23 micrometers for Pentacam and -69 micrometers to 43 micrometers for Orbscan II. Preoperatively, CCT measurements were higher with Orbscan II as compared to ultrasound. Postoperatively, both Pentacam and Orbscan II measurements were lower than those obtained with ultrasound, but Pentacam had better agreement. The use of ultrasound, as the gold standard method, or Pentacam both appear to be preferable over Orbscan II among patients with high myopia.

Graft versus host disease (GVHD) is a common complication of allogeneic stem cell transplantation (allo-SCT). Ocular GVHD develops in approximately 40-60% of patients following allo-SCT and its most common clinical manifestations include keratoconjunctivitis sicca and cicatricial conjunctivitis. Ocular GVHD may lead to severe ocular surface disease, which can significantly diminish quality of life and restrict daily activities. It is thus important to monitor the condition closely since with timely diagnosis, irreversible damage can be avoided. The current review will focus on updated information regarding ocular GVHD.

To determine the association between astigmatism and spherical refractive error in a clinical population In this cross-sectional study, 2,000 patients who presented to our optometry clinic were enrolled. All were tested for objective refraction with a Nidek AR-310A auto refractometer, and non-cycloplegic refraction. For those under 15 years of age, cycloplegic refraction was measured as well. Myopia and hyperopia were defined as a spherical power of -0.5 Diopter (D) or less and +0.5 D or greater, respectively. Astigmatism was defined as a cylinder power of ≥-0.5 D; with-the-rule (WTR) astigmatism if the steep axis was 0±20°, against-the-rule (ATR) astigmatism if the steep 90±20°, and oblique if the axis was in between. The mean age of the participants in this study was 31.52±18.39 years, and 910 (45.5%) were male. The Mean cylinder power of the subjects with high myopia and high hyperopia was 1.92±0.25 and 1.48±0.19 D, respectively. The lowest prevalence of astigmatism was found in subjects with emmetropia (P<0.001). There was an age-related decrease in the prevalence of WTR astigmatism, and an increase in ATR and oblique astigmatism (P<0.001). Mean cylinder error in WTR, ATR, and oblique astigmatism groups was 1.59±1.24, 1.10±0.76, and 1.16±0.04 D, respectively (P<0.001), and absolute mean spherical error was 1.97±2.03, 1.49±1.54, and 1.68±1.71 D, respectively (P<0.001). The results of this study indicated an association between astigmatism and spherical refractive error. Higher amounts of astigmatism were seen in subjects with high spherical ametropia. Astigmatism axis was related to the cylinder and spherical powers which were both higher in subjects with WTR than those with ATR and oblique astigmatisms. In those with ATR astigmatism with the refractive status was close to emmetropia.

To determine the effect of carpet weaving on refractive errors In this cross sectional study, carpet weavers and non-weavers in the normal population of Mashhad were regarded as exposed and non-exposed groups, respectively. A carpet weaver was a person who wove carpets 7 hours a day for at least 2 years. The non-weavers group was selected from the population of Mashhad through stratified cluster sampling. The variables of age, gender, education, with respect to their frequency, were matched between the two groups. In this study, 266 carpet weavers (exposed individuals) and 549 non-weavers group (non-exposed individuals) were evaluated. The prevalence of myopia was 78.9% in carpet weavers and 19.0% in non-weavers [Odds ratio (OR)=16.03, 95% confidence interval (CI)=11.13-23.09]. The prevalence of hyperopia was 6.02% in carpet weavers, and 56.75% in non-weaver group (OR=0.05, P<0.001). The prevalence of astigmatism was 39.47% in carpet weavers and 21.46% in non-weavers. The odds of against-the-rule (ATR) astigmatism was 1.72 times more in carpet weavers as compared to non-weavers (P<0.001). The results of this study showed that carpet weaving had a strong correlation with myopia. In addition to myopia, the prevalence of astigmatism, specially ATR astigmatism, was higher in carpet weavers.

To evaluate the correlation of central corneal thickness (CCT) with refractive error and keratometry in a group of patients eligible for laser keratorefractive surgery, which may serve as a bias in studies on intraocular pressure (IOP) measurement In a cross sectional observational study, the right eyes of 340 patients who underwent laser keratorefractive surgery during the year 2006 were included. The CCT was measured with ultrasound pachymetry. The refractive error, including sphere, cylinder, and spherical equivalent (SE), based on cycloplegic refraction. Keratometry (K) readings were derived from topography printouts. The correlation between refractive indices and CCT was investigated in all cases and also in refractive subgroups. The mean±SD age of the patients was 28.7±7.7 years, ranging from 18 to 55 years. Seventy percent of the patients were female. The mean cycloplegic SE and CCT were -3.2±2.3 diopters (D) and 549.5±33.6 µm, respectively. A borderline negative correlation between age and CCT was observed (r=-0.1, P=0.05). None of the other parameters including gender, amount of refractive error (Sphere, cylinder and axis), and K-readings showed any significant correlation with CCT (P>0.05) in the whole group or different subgroups. In this refractive surgery population, refractive indices did not show any significant correlation with CCT. This suggests that the correlation between CCT and IOP which has been found by other investigations in similar populations is in accordance to our findings.

To compare thickness of central cornea measured using Pentacam, Orbscan II, and ultrasound pachymeter

Patients with no history of corneal diseases or systemic diseases affecting eyes, who did not wear contact lens or use eye medications, and who with no previous history of corneal surgery were selected for this study. Central corneal thickness (CCT) was measured by three methods using Pentacam, Orbscan II, and ultrasound pachymeter.

Comparison of ultrasound and Orbscan CCT measurements showed a relatively high correlation between these two devices (P<0.001; r=0.891). The 95% limits of agreement (LoA) between these two devices were -42.44 to 20.18 µm. There was also a high correlation between the results obtained through ultrasound and Pentacam (P<0.001; r=0.932). The 95% LoA of CCT with ultrasound and Pentacam were -13.35 to 24.16 µm. There was also a high correlation between CCT measurements carried out by Orbscan and Pentacam (P<0.001) and the 95% LoA were -12.14 to 45.19 µm.

The findings of the present study demonstrated high agreements between the CCT readings measured with Orbscan, Pentacam, and ultrasound. The agreement between the Pentacam and ultrasound measurements was higher than that of between Orbscan and ultrasound, making Pentacam a better substitute for ultrasound.