farideh sharifipour

To investigate the effect of static accommodative tasks on intraocular pressure (IOP) of glaucomatous and normal eyes.

Four groups of subjects categorized as primary open-angle glaucoma (POAG), primary angle-closure suspects (PACS), normal age-matched controls, and normal young adults (NYA; age <40 years) were enrolled. The baseline IOPs were measured after the subjects were looking at a distant target for 15 min. Static accommodation was obtained by execution of near vision tasks (reading at 33 cm in daylight [300 lux] for 60 min). IOPs were measured at 15, 30, 45, and 60 min intervals while accommodating and then measured again after 15 min of relaxing accommodation while looking at a distant target.

One-hundred and eighteen eyes of 98 subjects were recruited. The study groups consisted of the following categories: 25 POAG (46 eyes), 24 PACS (47 eyes), 25 matched controls (50 eyes), and 24 NYA (48 eyes). Within all groups, the mean IOP decreased throughout the accommodation period at all time points. Maximum IOP reduction after accommodation was detected at the 30-min time among the POAG subjects, at the 45-min time in the PACS and matched control groups, and at 15 min after the relaxation of accommodation in the NYA group. IOP reduction levels showed no statistically significant difference among POAG, PACS, and the normal matched groups in their response to accommodation. However, NYA had significantly lower IOP and greater IOP reduction after the resting period (relaxation of accommodation).

Static accommodative tasks can significantly reduce IOP in normal, POAG, and PACS individuals. Encouraging glaucoma patients to practice periodical near vision tasks could be viewed as an adjunctive measure for glaucoma management.

To estimate the power of an implanted intraocular lens (IOL) by measuring IOL thickness using anterior segment optical coherence tomography (AS-OCT) and to assess the repeatability of measurements.

Ninety-seven eyes were studied one month after uneventful phacoemulsification within the bag Acrysof SA60AT IOL implantation (range +11 to +35). All eyes had postoperative refraction of ±0.5 D of target refraction. AS-OCT was used to measure the central thickness of the IOL. Correlation between labelled IOL power and central IOL thickness as well as the measure of repeatability, for example, intraclass correlation coefficient (ICC), were evaluated. IOL thicknesses were also calculated using a formula and compared with AS-OCT derived measurements.

IOL thickness correlated significantly with labelled IOL power (R2 = 0.985, P < 0.001). The regression equation (IOL Power = [0.04 × IOL thickness in micron] – 7.56) indicates 25 microns of central IOL thickness change per 1D power change. Over the studied range, IOL power could be estimated with a precision of 0.85 ± 0.02 D (95% confidence interval: 0.83–0.94D). ICC for repeated measurements was 0.999. There was a significant correlation between calculated and measured (AS-OCT) IOL thickness (R2 = 0.984, P < 0.001).

Central IOL thickness measurements with the AS-OCT are highly repeatable and closely correlated with the labelled IOL power, which can predict the IOL power with ±0.85 D from the actual power. This method can be helpful in cases of postoperative IOL surprise.

To evaluate intraocular pressure (IOP) and corneal biomechanical changes after water‑drinking test (WDT) in glaucomatous and normal eyes using Ocular Response Analyzer (ORA).

This prospective study included 30 medically controlled, 30 surgically treated glaucoma patients and 30 normal individuals. Baseline measurements included central corneal thickness (CCT), ORA‑derived corneal hysteresis (CH), corneal resistance factor (CRF), corneal‑compensated IOP (IOPcc), and Goldmann‑correlated IOP (IOPg). Measurements were repeated 15, 30, and 60 min after drinking 1000 mL of water. Changes in ORA parameters were compared among the groups.

All groups showed a significant increase in IOPg and IOPcc at all test points. Peak IOP occurred at 15 min and decreased gradually over time but did not reach the baseline values at 60 min. The surgery group had significantly lower baseline IOPg and IOPcc (10.7 ± 3.1 and 12.8 ± 3.7 mmHg, P = 0.001 and 0.01), lower peak IOPg and IOPcc (14.4 ± 4.6 and 16.2 ± 4.6 mmHg, P = 0.003 and 0.034), and lower percent IOPg and IOPcc fluctuations (13 ± 5.6 and 15 ± 5.9, P = 0.0001 and 0.002), respectively, compared to the medical group. Baseline CH and its fluctuations were not significantly different among the groups. CH decreased to a trough corresponding to peak IOPcc. There was a significant negative correlation between IOPcc and CH (r = −0.609, P < 0.001). The medical group showed more CRF fluctuations compared to normal group.(P = 0.039).

Surgically treated glaucomatous eyes show less IOP fluctuations and lower peak IOP after WDT compared to medically controlled and normal eyes.

Surgical procedures are used as 1 of the main treatment modalities for pediatric glaucoma, even though progression may occur. In this study, we aimed to investigate the risk factors affecting the progression of pediatric glaucoma.

In this retrospective cohort study, we reviewed the medical records of patients diagnosed with pediatric glaucoma between April 2009 and March 2017. Pediatric glaucoma patients who underwent regular follow-up for at least 1 year were included. Demographics, intraocular pressure (IOP), central corneal thickness (CCT), axial length (AL), cup-to-disc ratio (C/D ratio), corneal diameter, type of glaucoma, age at time of diagnosis, and age at surgery were recorded. Progression was defined as an increase in AL > 2 mm, C/D ratio > 0.2, or corneal diameter > 1 mm during 1 year of follow-up.

Eighty-three eyes from 46 patients were included: 37 eyes (45%) with primary congenital glaucoma (PCG), 46 eyes (55%) with secondary glaucoma, and 27 of these 83 eyes (32.5%) showed progression. Progression was comparable between eyes with PCG and secondary glaucoma (PCG, 22%; secondary glaucoma, 41%; P = 0.152). Age at the time of diagnosis and age at the time of the first surgery were significantly lower in the eyes with progression ( P = 0.046 and 0.012, respectively). The mean ± standard deviation of surgeries in progressed versus non-progressed eyes was 1.88 ± 1.1 versus 1 ± 0.8 ( P = 0.015). The frequency of comorbid systemic disease was significantly higher in patients with glaucoma progression ( P = 0.043). The progressed and non-progressed eyes were comparable in terms of other demographic characteristics and ocular parameters (all P > 0.05).

Pediatric glaucoma patients who were younger at the time of diagnosis and the first glaucoma surgery and those with comorbid systemic disease are at higher risk of glaucoma progression. These findings are useful for clinicians when counseling parents of children with pediatric glaucoma about disease outcomes. However, future prospective studies with larger sample sizes and longer follow-up periods are needed to confirm our findings.

To report the short-term outcomes of modified deep sclerectomy (MDS) in the management of open angle glaucoma. This prospective, non-randomized, controlled study included 105 eyes (105 patients) with open angle glaucoma. Eyes were categorized as follows: trabeculectomy (30 eyes), MDS (27 eyes), phacotrabeculectomy (28 eyes), and phaco-MDS (20 eyes). The MDS technique involved removal of a third scleral flap to expose the suprachoroidal space and excision of a trabecular block. A two-site approach was used for combined surgeries. Main outcome measures included intraocular pressure (IOP), number of glaucoma medications, and complications. Treatment success was defined as an IOP of 6–15 mmHg and/or a 30% reduction in IOP. All groups showed significant decrease in IOP and number of medications (both P s < 0.001). The MDS group had a higher IOP (13.9 ± 3.8 vs. 12.4 ± 2.5 mmHg, P = 0.080) and required more medications (P = 0.001) than the trabeculectomy group at 1 year. The MDS group had a higher baseline IOP than the trabeculectomy group (P = 0.004) and both the groups showed similar IOP reductions (33.3% vs. 25.7%, P = 0.391). The phaco-MDS and phacotrabeculectomy groups had comparable IOP (13.3 ± 3.1 vs. 12.4 ± 3.1 mmHg, P = 0.354), number of medications (P = 0.594), and IOP reduction (P = 0.509) at 1-year follow-up visit. The trabeculectomy and phacotrabeculectomy groups developed more wound leaks (P = 0.043) and required more bleb needling during the early postoperative period (P < 0.001). The MDS technique seems to be slightly inferior to trabeculectomy, but when combined with phacoemulsification, is safer and results in similar IOP outcomes.

To present a case of total Descemet’s membrane detachment (DMD) after trabeculectomy and its surgical management.
Case Report: A 68‑year‑old woman presented with large DMD and corneal edema one day after trabeculectomy. Intracameral air injection on day 3 was not effective. Choroidal effusion complicated the clinical picture with Descemet’s membrane (DM) touching the lens. Choroidal tap with air injection on day 6 resulted in DM attachment and totally clear cornea on the next day. However, on day 12 the same scenario was repeated with choroidal effusion, shallow anterior chamber (AC), and DM touching the lens. The third surgery included transconjunctival closure of the scleral flap with 10/0 nylon sutures, choroidal tap, and intracameral injection of 20% sulfur hexafluoride. After the third surgery, DM remained attached with clear cornea. Suture removal and needling bleb revision preserved bleb function. Lens opacity progressed, and the patient underwent uneventful cataract surgery 4 months later.
Scleral flap closure using transconjunctival sutures can be used for DMD after trabeculectomy to make the eye a closed system. Surgical drainage of choroidal effusions should be considered to increase the AC depth.

To determine age-related changes in corneal viscoelastic properties in healthy individuals.

This observational cross-sectional study was performed at the Department of Ophthalmology, Imam Khomeini Hospital, Ahvaz, Iran and included 302 healthy individuals in 6 age decades (range: 10–69 years). After complete ocular examination, corneal viscoelastic properties were measured by ocular response analyzer and central corneal thickness (CCT) by an ultrasonic pachymeter. Our main outcome measures were corneal viscoelastic properties in different age groups.

Corneal hysteresis (CH) and corneal resistance factor (CRF) showed a significant negative correlation with age (P

In this study, there was a decrease in CH and CRF with an increase in age. Hyperopia and female gender are associated with higher CH and CRF. CCT is higher toward the extremes of life and is significantly correlated with CH and CRF.

To evaluate diurnal variations in intraocular pressure (IOP), central corneal thickness (CCT), and macular and retinal nerve fiber layer (RNFL) thickness in diabetic patients and normal individuals.
This study included 11 diabetic patients with macular edema and 11 healthy individuals. IOP, CCT, and macular and RNFL thickness were measured every 3 hours on a single day between 9 AM and 6 PM. Diurnal variations in IOP, CCT, total macular volume (TMV), central macular thickness (CMT), average macular thickness (AMT), and RNFL thickness were measured.
None of the parameters showed a significant absolute or relative change over the course of the day. However, the following non‑significant changes were observed. In the control group, all parameters demonstrated the highest values at 9 AM. The lowest IOP, TMV and AMT occurred at 12 PM; lowest CCT and RNFL at 6 PM; and the lowest CMT at 3 PM. Diabetic subjects had the highest values of RNFL, CMT and TMV at 9 AM, and that for IOP, CCT and AMT at 6 PM. The lowest RNFL and CMT values occurred at 6 PM; lowest IOP at 12 PM; and the lowest CCT, TMV and AMT were observed at 3 PM. In the diabetic group, TMV, CMT, AMT and CCT were significantly higher and RNFL was significantly lower than the control group at all time points (all P-values While there were slight decreases in IOP, RNFL thickness and CMT during the day, these changes were not significant between 9 AM and 6 PM and probably do not affect the interpretation of measurements.

A 19‑year‑old male with congenital hereditary endothelial dystrophy (CHED) presented with severe bilateral corneal clouding precluding any view of the intraocular structures. He underwent modified Descemet’s stripping automated endothelial keratoplasty (DSAEK) technique including a suture pull‑through technique to prevent lens damage. Surgery resulted in progressive clearing of the cornea and decreased corneal thickness. Visual acuity increased from hand motions preoperatively to counting fingers at 4 m after 4 months. DSAEK can be successfully performed in phakic eyes with CHED as an alternative to penetrating keratoplasty. It has the advantage of less wound problems and better preservation of globe integrity especially in children.

Epithelial rejection typically begins in a linear pattern from the periphery of the graft and progresses centripetally. Here in, we reported a patient with a new presentation of corneal epithelial graft rejection.. A 23-year-old man presented with blurred vision two months after penetrating keratoplasty.. Slit lamp examination revealed sharply demarcated, diffuse epithelial opacity in corneal graft with peripheral sparing and clear cornea in between suture lines. Epithelial rejection responded to corticosteroid therapy..

To determine the incidence and risk factors associated with glaucoma following congenital cataract surgery (CCS) in children under age of 15 This prospective cohort (since 2006) consisted of children less than 15 years of age who underwent cataract surgery with or without intraocular lens (IOL) implantation. The role of the following factors on the development of glaucoma after CCS including age at surgery, gender, laterality of the cataract, IOL implantation, congenital ocular anomalies, intra- and postoperative complications, length of follow-up, central corneal thickness (CCT) as well as the effect of the age of onset, time to development of glaucoma, and response to treatment were evaluated. Overall, 161 eyes of 96 patients were included in this study of which 28 eyes developed glaucoma. Incidence of glaucoma was 17.4%. Mean±SD age at surgery was 9.3±6.9 (range, 1-24) months in glaucomatous and 40.4±41.1 (range, 1 m-13.6 year) months in non-glaucomatous group (p<0.001). All glaucoma patients had the operation under two years of age. In group 1, 9 (60%) and in group 2, 24 (30%) patients were female (p=0.001). In group 1, 17 eyes (60.7%) and in the group 2, 41 eyes (30.8%) were aphakic (p=0.001). Mean time to diagnosis of glaucoma was 111.2 days (range 30-1200 days). Mean follow-up time was 3.1 years (range, 1-6 years). In 22 (78.6%) eyes glaucoma was diagnosed within six months after surgery. Glaucoma was controlled with medications in 23 eyes (82%) and with surgery in five eyes. In this study the incidence of glaucoma after CCS was 17.4% over a follow-up period of six years. Younger age at the time of lensectomy increases the risk of secondary glaucoma. IOL implantation may protect against glaucoma. Female gender was affected more than male.

To report a young child with bilateral keratoconus in the context of vernal keratoconjunctivitis (VKC) who developed bilateral corneal hydrops associated with eye rubbing, and to discuss the pathogenesis and review the pertinent literature. Case Report: A seven-year-old girl with VKC and asymmetric keratoconus developed corneal hydrops due to habitual eye rubbing. Corneal edema subsided within 16 weeks in her right eye and 9 weeks in the left eye with subsequent corneal scarring. Continuous mechanical trauma, such as eye rubbing, plays a significant role in the pathogenesis of keratoconus and subsequent hydrops even in childhood.

To measure oxygen tension in the aqueous humor of human eyes under different oxygenation conditions. This prospective comparative interventional case series consisted of two parts. In the first part, 120 consecutive patients scheduled for cataract surgery were randomized into group I (control group) in which surgery was performed under local anesthesia inhaling 21% oxygen; group II in whom general anesthesia using 50% oxygen was employed; and group III receiving general anesthesia with 100% oxygen. After aspirating 0.2 ml aqueous humor under sterile conditions, the aqueous sample and a simultaneously drawn arterial blood sample were immediately analyzed using a blood gas analyzer. In part II the same procedures were performed in 10 patients after fitting a contact lens and patching the eye for 20 minutes (group IV) and in 10 patients after transcorneal delivery of oxygen at a flow rate of 5 L/min (group V). Mean aqueous PO2 in groups I, II and III was 112.3±6.2, 141.1±20.4, and 170.1±27 mmHg, respectively (P values)

To evaluate the effects of topical sesame oil in the treatment of severe corneal alkali injury in rabbits In a double-blind experiment, 30 healthy white rabbits were randomized into a sesame oil treatment group (n=15) and a control group (n=15). Under general anesthesia, severe corneal alkali injuries were induced by application of 1 N sodium hydroxide for 40 seconds to the right eye of each rabbit. The sesame oil group was treated with sesame oil drops 4 times daily for 1 month. Both groups received chloramphenicol eye drops, 4 times daily. Daily examination with fluorescein staining and photography were performed, and details of corneal erosion and ulceration were recorded. The main outcome measure was descemetocele and perforation of the cornea. The animals were euthanized at the end of the study or earlier if corneal perforation had occurred, and the corneas were excised and fixed in 10% neutral-buffered formalin for histologic examination. Mean time to perforation in sesame oil group was longer than control group (29.6 versus 25.5 days, respectively; P=0.01). Four eyes in sesame oil group and 8 eyes in control group developed descemetocele and perforation (P=0.13). Extent of corneal vascularization was 66.6% in sesame oil group and 49.3% in control group (P= 0.065). Topical sesame oil seems to have beneficial effects on alkali-injured corneas. It delays corneal perforation in rabbits compared to control group.

To investigate the efficacy of normobaric oxygen (NBO) therapy for treatment of scleral ischemia or melt. This prospective interventional case series includes 9 eyes of 8 patients with scleral ischemia or melt of diverse etiologies. Following the failure of conventional medical and/or surgical therapy to improve ischemia or upon clinical deterioration، NBO was initiated. All patients received 100% NBO at flow rate of 10 liters/minute by face mask for 1 hour، twice daily until complete vascularization of ischemic areas. Main outcome measures were improvement of scleral ischemia and healing of conjunctival epithelial defects. NBO therapy led to epithelialization and vascularization of the ischemic sclera in all eyes; the repair process began 3-4 days after NBO had been initiated and was completed in 18. 1±4. 7 (range، 10-25) days. All patients remained stable over a 9-month follow-up period. NBO therapy seems effective for treatment of scleral ischemia or melt، and hence can be considered as a non-invasive alternative to surgical intervention in these conditions.

Oxygen therapy, as a therapeutic modality, can be used for long periods of times. However, it may be accompanied by potential complications and side effects. To evaluate the side effects of normobaric oxygen therapy in rabbits. In a double-blind experiment, 28 white New Zealand rabbits were randomized into an oxygen treatment group (n = 14) and a control group (n = 14).The oxygen treatment group received 100% oxygen at a flow rate of 5 L/min for 1 h daily,for 1 month. The animals were euthanized at the end of the study, and following autopsya histological evaluation was carried out to detect levels of oxygen toxicity in their;lungs, liver, brain, heart, kidney, eyes and spleen. Histological evaluation revealed no evidence of toxicity in the examined tissues,compared with the control group. Oxygen therapy at a flow rate of 5 L/min for 1 h daily for 1 month had no systemic toxicity and it appears to be safe in rabbits.

To compare anterior segment and ocular biometric parameters in unaffected fellow eyes of patients with a previous attack of acute angle closure (AAC), primary angle closure suspect (PACS) eyes, and normal eyes; and to identify eyes at high risk of AAC among primary angle closure suspects. In this case-control study, 16 unaffected fellow eyes of patients with a previous attack of AAC (group I), 20 PACS eyes (group II) and 18 normal eyes (group III) underwent Pentaca and A-scan echography. Mean anterior chamber volume was 72±18, 77±18 and 176±44? l in groups I, II, and III, respectively (P)