فهرست مطالب kiana hassanpour

To evaluate and compare clinical outcomes after femtosecond laser-assisted implantation of 325-degree versus 340-degree arc length intracorneal ring segments (ICRS) in eyes with keratoconus (KCN).

In this prospective non-randomized interventional case series, 23 eyes of 21 patients diagnosed with KCN, underwent femtosecond laser-assisted implantation of two types of ICRS, which included a 325-degree ICRS (Group 325) and a 340-degree ICRS (Group 340). The primary outcome measures were uncorrected distance visual acuity (UDVA), and the secondary outcome measures included corrected distance visual acuity (CDVA), sphere, cylinder, mean refractive spherical equivalent (MRSE), keratometry, vectorial change in corneal astigmatism, and the location of maximum keratometry relative to the corneal apex. The study groups were compared using the primary and secondary outcome measures obtained at postoperative months six and 12.

Groups 325 and 340 consisted of 10 and 13 eyes, respectively. The two groups were comparable in terms of parameters measured preoperatively. On comparison to the baseline values, both study groups exhibited a significant increase in UDVA and CDVA measured at postoperative month six (Ps < 0.05) and a significant decrease in the sphere, cylinder, spherical equivalent refraction, and keratometry readings measured at postoperative months six and 12 (Ps < 0.05). No significant differences were observed between the two groups in terms of visual, refractive, and keratometric outcomes at any time point. No intraoperative or postoperative complications were observed in any of the study groups.

Both the 325-degree ICRS and the 340-degree ICRS effectively and equally improved visual, refractive, and keratometric outcomes in keratoconic eyes.

To evaluate the efficacy of opportunistic case finding in glaucoma detection and to determine factors associated with failure of glaucoma detection by eye health providers.

This study was conducted on 154 new definite primary open‑angle glaucoma (POAG) patients presenting to our glaucoma clinic. A questionnaire was prepared to determine if these subjects had sought eye care up to 12 months before presentation. The type of eye care provider and the principal reason for the visit were probed. The primary outcome measure was the frequency of a correct glaucoma diagnosis in their index visit. The secondary outcomes were factors associated with missed POAG diagnosis.

The great majority of study subjects (132 cases, 85.7%) had sought at least one ocular examination within 1 year before presentation. Among these patients, 73 cases (55.3%) had remained undiagnosed after the examination. Among the probed variables, age, gender, visual acuity, visual field defects, intraocular pressure, cup/disc ratio, nerve fiber layer thickness of the worse eye at presentation, and family history of glaucoma were comparable between correctly diagnosed and missed POAGs. The only factors significantly associated with missed POAG diagnosis were lack of significant refractive errors and visiting an optometrist rather than an ophthalmologist.

The efficacy of opportunistic case finding for POAG seems to be less than ideal in our settings. Lack of a significant refractive error and visiting an optometrist rather than an ophthalmologist were associated with a missed diagnosis of POAG. These observations reflect the need to adopt policies to improve glaucoma screening by eye care providers.

To investigate and optimize the accuracy of aphakic refraction (AR) techniques for secondary intraocular lens (IOL) power calculation in aphakic children.

Thirty-three aphakic eyes of 18 patients who were candidates for secondary IOL implantation were enrolled in the present study. Axial length (AL) measured by optical biometry was used in the biometric formula (SRK-T, Holladay II, and Hoffer-Q). AR and spherical equivalent (SE) were used in two AR-based formulas (Ianchulev, Leccissotti). True power was calculated based on postoperative SE at three months’ follow-up.

Regarding the postoperative SE, 13 (40%) eyes were within ±1.00 diopters (D) and 22 (66%) were within ±2.00 D. Median absolute error (MedAE) was predicted to be 4.4 and 7.3 D with the use of Ianchulev and Leccissotti formulas, respectively. The corresponding value was 0.8 D with the biometric formula. All eyes were deemed to have myopic refraction when using the AR-based formulas except one eye with the Ianchulev formula. The coefficient of our modified formula was 1.7 instead of 2.01 in the Ianchulev formula. MedAE with the use of new formulae was 0.5 D and was comparable with the true IOL power (P = 0.22).

Both Ianchulev and Leccissotti formulas resulted in a significant myopic surprise in aphakic children aged between 4.5 and 14 years. The modified formula proved to determine a more accurate SE that is comparable with biometric formulas.

To compare the efficacy of subconjunctival injection of an anti-connective tissue growth factor antibody (anti-CTGF) versus mitomycin-C (MMC) and placebo in reducing scar formation in a rabbit model of trabeculectomy.

A total of 14 rabbits were included. Nine rabbits underwent trabeculectomy with subconjunctival injections of either anti-CTGF antibody, MMC, or balanced salt solution (BSS), each administered in three eyes, before peritomy. The anti-CTGF group received a repeated dose of the antibody five days after surgery. All nine rabbits were euthanized on day 14; the globes were stained with hematoxylin & eosin, Masson’s Trichrome, and immunohistochemistry for detecting alpha-smooth muscle (α-SMA) actin. RNA extraction was performed on five eyes of the remaining rabbits which included one eye without any surgery, one eye 5 hr after trabeculectomy without any injection, one eye five days after trabeculectomy without any injection, and two eyes five days after trabeculectomy with administration of MMC and BSS, respectively.

The mean bleb area in the anti-CTGF, MMC, and control groups was 3.8 ± 1.45, 5.9 ± 1.4, and 3.5 ± 1.9 mm2 , respectively. Collagenous tissue was found to occupy the bleb area by 13.7%, 13.5%, and 18.5%, respectively. This ratio was significantly higher in the BSS group (P = 0.04). The expression of CTGF mRNA after 5 hr and five days in eyes undergoing trabeculectomy were significantly more pronounced as compared to the unoperated eye. The mean H-SCORE of α-SMA-immune reactive cells calculated as the grade of staining multiplied by the percentage of immune stained cells was 14.6, 10.22, and 140.58 in the anti-CTGF, MMC, and control groups, respectively. While the control eyes had a significantly higher score (Ps < 0.001), the anti-CTGF and MMC groups were comparable (P = 0.87).

Based on the results of this animal study, the anti-CTGF antibody injection resulted in a significant reduction in collagenous tissue and myofibroblast cells after trabeculectomy.

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.

Background and Aims :

Blindness is one of the major health problems and diseases, such as corneal opacity, cataracts, glaucoma, and age-related macular degeneration due to diabetes are recognized as the most important causes of bilateral blindness worldwide. Among these factors, corneal diseases are considered as an important cause of blindness. The aim of this study was to review the prevalence, causative agents, treatment methods, and also the use of keratoprosthesis or artificial cornea as the last option to restore vision to blind patients with severe corneal injuries.

Methods :

Studies related to the subject were collected and reviewed using valid databases, such as PubMed and Google Scholar.

 Results :

Out of more than 1000 articles in the field of the artificial cornea, about 70 related articles were selected and reviewed.

Conclusion :

Generally, keratoprosthesis is used for patients for whom corneal transplantation is not possible or the risk of corneal transplantation rejection is high. The patient’s current condition and the outcome of the patient’s anterior and posterior segment examinations, previous treatments and surgeries, and the medications used should be considered. If a person has advanced retinal disease or glaucoma, he/she is not a good candidate for keratoprosthesis. If the patient’s vision in either eye is within the range of light perception or hand movement detection, while the optic nerve and macula are healthy, it is appropriate to use keratoprosthesis. It can be said that there is still no type of keratoprosthesis that can be used without side effects and for all patients in need, but researchers are still trying to improve the quality of keratoprostheses, which can restore patients’ lost vision with minimal complications.

To evaluate the efficacy of second trabeculectomy with mitomycin C among patients with previous failed trabeculectomy.

This retrospective study included 23 eyes of 23 patients with failed trabeculectomy who underwent second trabeculectomy with mitomycin C at Imam Hussein Medical Center, Tehran, Iran, between January 2010 and December 2017. Pre and post operative intraocular pressure (IOP), number of medications, surgical success rate and post operative complications were recorded. The primary outcome was surgical success defined as IOP ≤ 18 mmHg according to criteria A and IOP ≤ 15 mmHg according to criteria B.

The mean age of patients entering the study was 54.95 ± 14.32 years. There was a significant decrease of the mean IOP post operatively at all postoperative follow ups (P < 0.001 for all follow ups) up to 2 years. Also there was a significant decrease in the mean number of IOP reducing drugs needed post operatively at all postoperative follow ups (P < 0.001 for all follow ups). The success rate per criteria A was from 96 % three months after surgery to 87 % two years after surgery. The success rate per criteria B was from 87 % three months after surgery to 74 % two years after surgery.

Based on our results second trabeculectomy seems to be an effective method for controlling the IOP among patients with failed first trabeculectomy.

We reported a case of corneal perforation due to longstanding exposure keratopathy treated successfully with lamellar corneal patch graft, conjunctival flap, and lateral tarsorrhaphy. A 75-year-old male presented with ocular pain and decreased visual acuity in his right eye since 2 weeks ago. On external examination, lagophthalmos in the right eye was evident. Visual acuity was hand motion on slit-lamp examination. 2×3 mm perforated area in the right cornea accompanied by adjacent corneal melting and diffuse punctate epithelial keratopathy were observed. The anterior chamber was flat. Intraoperatively, a 7×2.5 mm-diameter corneal patch graft was fashioned manually; its thickness was reduced and placed over the perforated area, successfully sealed the cornea, a partial bipedicle conjunctival flap was also applied over the graft, and lateral tarsorrhaphy was performed. Four weeks after surgery, Corrected Distance Visual Acuity (CDVA) improved to Counting Finger (CF) 20 cm. The lamellar corneal patch graft was intact without a leak, and the conjunctival flap was partially removed retracted. Corneal perforation can occur in patients with severe exposure to keratopathy, and corneal patch graft is a good option when a sizeable corneal perforation (≥3 mm diameter) is not amenable to corneal gluing.

To present the optical coherence tomography angiography (OCTA) findings of the radial peripapillary capillary (RPC) network in an individual with severe bilateral methanol-induced toxic optic neuropathy (MTON) in comparison to a normal subject and a patient with retinitis pigmentosa.

A 35-year-old man with severe bilateral MTON was referred to the neuro-ophthalmology clinic at the Labbafinejad Medical Center. The Angio Vue OCT 3D set of 4.5 × 4.5 mm was used to measure the disc and peripapillary vessel density. Two subjects were examined with the same protocol as controls to determine the effect on the RPC vessel density in multiple scenarios. One of the controls was a healthy individual with the prerequisite matches of age and sex while the second one was a known retinitis pigmentosa (RP) patient. RPC density was measured as 37.7 in the patient with MTON, 46.9 in the RP patient, and 54.7 in the healthy control.

The reduction in the RPC vessel density in a patient with MTON compared to that of a healthy individual and also a patient with RP may be due to the loss of capillaries secondary to the loss of nerve fibers and ganglion cells. Moreover, MTON can be considered an optic neuropathy with direct mitochondrial damage to the endothelial cells of the capillaries.

Optic disc pits are rare and congenital or acquired anomalies of the optic disc, usually remaining asymptomatic. However, serous macular detachment or optic disc maculopathy is the most common complication, causing significant visual deterioration, without a current consensus about treatment. A 55-year-old woman with a past medical history of diabetes mellitus and systemic hypertension was referred for an abnormal finding in the retina. The Corrected Distance Visual Acuity (CDVA) was 20/40 in the right eye and 20/30 in the left eye. Marcus-Gunn was negative and Slit-lamp biomicroscopy revealed no pathologic findings in both eyes. Funduscopic examination showed an excavation in the inferotemporal part of the Optic Nerve Head (ONH) with serous macular detachment extending to the optic disc. Based on clinical examination and paraclinical imaging fluorescein Angiogeraphy (FAG) Optical Coherence Tomography (OCT), optic pit maculopathy was diagnosed and the patient underwent Juxtapapillary Laser Photocoagulation (JLP). After 2 years of follow-up, there were anatomical and functional improvements.

To report a patient with avascular bleb after trabeculectomy who showed promising results after subconjunctival erythropoietin injection.

Case Report:

 A 45-year-old woman with the diagnosis of primary open-angle glaucoma and history of trabeculectomy three years prior was admitted to our center. The corrected distance visual acuity (CDVA) was 20/20 in both eyes. Her ocular examination revealed an avascular and cystic bleb in the right eye. Seidel test was negative while bleb sweating was observed after fluorescein staining of the bleb area. Intraocular pressure (IOP) was 5 mmHg in the right eye. Erythropoietin (2000 unit in 0.1 ml) was injected subconjuctivally around the bleb area in the temporal quadrant. Six weeks after the injection, the bleb area just superior to the conjunctiva showed an increased fibrosis formation while the IOP remained the same as before injection.

Erythropoietin might play a role in preventing the progression of a cystic avascular or hypovascular bleb to a leaking bleb.

To evaluate the dimensions of lower punctum in a sample of Iranian normal population using spectral domain anterior segment optical coherence tomography (OCT).

In this cross‑sectional study, 102 eyes of 102 healthy volunteers were enrolled. All participants underwent a detailed history and complete ophthalmic examination. Lower punctum metrics were measured using OCT (Spectralis, Heidelberg) with the anterior segment module. External punctal diameter was defined as the largest diameter at the surface of the punctum. Internal punctal diameter was measured at two different depths of 100 µm and 500 µm from the external surface. Measurements were repeated for 30% of data by another grader. The agreement was measured using intraclass correlation coefficient (ICC).

The mean age of the participants was 61.5 ± 7.9 years. The mean external punctal diameter was 425.6 ± 124.3 µm. The mean internal punctal diameter at 100 µm and 500 µm was 183 ± 97.5 µm and 77.7 ± 51.4 µm, respectively. The agreement between the graders was high in assessing all punctal characteristics (ICC >0.9 for all measurements).

The spectral domain OCT can be used for measuring lower punctum diameter with acceptable reproducibility

To investigate the retinal vascular characteristics among patients with different types of inherited retinal dystrophies (IRDs).

This comparative cross‑sectional study was conducted on 59 genetically confirmed cases of IRD including 37 patients with retinitis pigmentosa (RP) (74 eyes), 13 patients with Stargardt disease (STGD) (26 eyes), and 9 patients with cone‑rod dystrophy (CRD) (18 eyes). Both eyes of 50 age‑ and sex‑matched healthy individuals were investigated as controls. All participants underwent optical coherence tomography angiography to investigate the vascular densities(VDs) of superficial and deep capillary plexus(SCP and DCP) as well as foveal avascular zone area.

In RP, significantly lower VD in whole image (P = 0.001 for DCP), fovea (P = 0.038 for SCP), parafovea (P < 0.001 for SCP and DCP), and perifovea (P < 0.001 for SCP and DCP) was observed compared to controls. In STGD, VD of parafovea (P = 0.012 for SCP and P = 0.001 for DCP) and fovea (P = 0.016 for DCP) was significantly lower than controls. In CRD, the VD of parafovea (P = 0.025 for DCP) was significantly lower than controls. Whole image density was significantly lower in RP compared to STGD (P < 0.001 for SCP) and CRD (P = 0.037 for SCP). VD in parafovea (P = 0.005 for SCP) and perifovea (P < 0.001 for SCP and DCP) regions was significantly lower in RP compared with STGD. Also, foveal VD in STGD was significantly lower than RP (P = 0.023 for DCP).

Our study demonstrated lower VDs in three different IRDs including RP, STGD, and CRD compared to healthy controls. Changes were more dominant in RP patients.

Sturge–Weber syndrome (SWS) or encephalotrigeminal angiomatosis is a non-inherited congenital disorder characterized by neurologic, skin, and ocular abnormalities. A somatic activating mutation (R183Q) in the GNAQ gene during early embryogenesis has been recently recognized as the etiology of vascular abnormalities in SWS. Approximately, half of the patients with SWS manifest ocular involvement including glaucoma as the most common ocular abnormality followed by choroidal hemangioma (CH). The underlying pathophysiology of glaucoma in SWS has not been completely understood yet. Early onset glaucoma comprising 60% of SWS glaucoma have lower success rates after medical and surgical treatments compared with primary congenital glaucoma. Primary angle surgery is associated with modest success in the early onset SWS glaucoma while the success rate significantly decreases in late onset glaucoma. Filtration surgery is associated with a higher risk of intraoperative and postoperative choroidal effusion and suprachoroidal hemorrhage. CH is reported in 40–50% of SWS patients. The goal of treatment in patients with CH is to induce involution of the hemangioma, with reduction of subretinal and intraretinal fluid and minimal damage to the neurosensory retina. The decision for treating diffuse CHs highly depends on the patient’s visual acuity, the need for glaucoma surgery, the presence of subretinal fluid (SRF), its chronicity, and the potential for visual recovery.

To investigate the indications, clinical outcomes, and complications of secondary piggyback intraocular lens (IOL) implantation for correcting residual refractive error after cataract surgery.

In this prospective interventional case series, patients who had residual refractive error after cataract surgery and were candidates for secondary piggyback IOL implantation between June 2015 and September 2018 were included. All eyes underwent secondary IOL implantation with the piggyback technique in the ciliary sulcus. The types of IOLs included Sulcoflex and three-piece foldable acrylic lenses. Patients were followed-up for at least one year.

Eleven patients were included. Seven patients had hyperopic ametropia, and four patients had residual myopia after cataract surgery. The preoperative mean of absolute residual refractive error was 7.20 ± 7.92, which reached 0.42 ± 1.26 postoperatively (P < 0.001). The postoperative spherical equivalent was within ±1 diopter of target refraction in all patients. The average preoperative uncorrected distance visual acuity was 1.13 ± 0.35 LogMAR, which significantly improved to 0.41 ± 0.24 LogMAR postoperatively (P = 0.008). There were no intraor postoperative complications during the 22.4 ± 9.5 months of follow-up.

Secondary piggyback IOL implantation is an effective and safe technique for the correction of residual ametropia following cataract surgery. Three-piece IOLs can be safely placed as secondary piggyback IOLs in situations where specifically designed IOLs are not available.

To assess the efficacy and survival rate of the Trabectome-mediated ab interno trabeculectomy combined with non-fenestrated Baerveldt glaucoma implant compared with the Baerveldt glaucoma implant alone.

In this retrospective comparative case series, 175 eyes undergoing primary glaucoma surgery (Baerveldt–Trabectome [BT] group: 60 eyes and Baerveldt [B] group: 115 eyes) were included. Participants were identified using the procedural terminology codes. Groups were then matched by Coarsened Exact Matching that resulted in the inclusion of 51 eyes in each group. The primary outcome measure was surgical success defined as 5 mmHg < intraocular pressure (IOP) ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline, and no need to reoperation for glaucoma. Secondary outcome measures were IOP, number of glaucoma medications, and best-corrected visual acuity (BCVA).

The cumulative probability of success at one year was 61% in the BT group and 50% in the B group. IOP decreased from 23.5 ± 2.4 mmHg at baseline to 14.1 ± 2.7 mmHg at the final follow-up in the BT group (P = 0.001). The corresponding values for the B group were 23.2 ± 2.0 mmHg and 13.9 ± 1.6 mmHg, respectively (P = 0.001). There was no significant difference between the groups in terms of IOP at the final follow-up (P = 0.56). The number of medications at baseline was 2.3 ± 0.3 in both groups. However, the BT group needed fewer drops at all postoperative time intervals and used 1.1 ± 0.3 versus 2.0 ± 0.4 eye drops (group B) at the final follow-up visit (P = 0.004). Eyes in B with phacoemulsification had a significantly higher IOP on day 1 compared to B (23.2 ± 14.3 versus 17.9 ± 11.4, P = 0.041). During the oneyear follow-up, 7 (13.7%) patients in BT group and 18 (35.2%) in B group experienced hypotony (P = 0.04). No dangerous hypotony or hypertension occurred in BT group. The mean BCVA at baseline was 0.64 ± 0.85 logMAR and changed to 0.55 ± 0.75 logMAR in BT and B groups, respectively (P = 0.663). The corresponding numbers for the final follow-up visit was 0.72 ± 1.07 and 0.63 ± 0.97 logMAR, respectively (P = 0.668).

We observed similar rates of success and IOP reduction using BT and B techniques. BT group needed fewer glaucoma medications. Tube fenestration was unnecessary in BT group resulting in less postoperative ocular hypotony and hypertension. The results of our study indicate that additional trabectome procedure makes Baerveldt glaucoma implant safer, easier to handle, and more predictable in the most vulnerable patients with advanced glaucoma.

To evaluate the long-term visual outcomes of ab externo trabeculotomy for primary congenital glaucoma (PCG) at a single pediatric ophthalmology center.

In this retrospective single-center case series, data from 63 eyes of 40 patients who underwent ab externo trabeculotomy between September 2006 and June 2018 were included. The data were analyzed for best corrected visual acuity (BCVA), stereopsis, and surgical success. Kaplan–Meier analysis was performed using the surgical success criteria defined as intraocular pressure (IOP) ≤ 21 mmHg and ≥ 20% below baseline without the need for additional glaucoma surgery.

BCVA at the time of diagnosis was 0.37 ± 0.48 logMAR, which changed to 0.51 ± 0.56 logMAR at the final follow-up (P = 0.08). Twenty-five percent of patients had BCVA equal to or better than 20/40 at the final visit. The mean refraction at baseline was –4.78 ± 5.87 diopters, which changed to less myopic refraction of –2.90 ± 3.83 diopters at the final visit. Optical correction was prescribed in 66% of eyes at the final visit. The average final stereopsis was 395.33 sec of arc. The linear regression model showed a significant association between the surgery success rate and final BCVA as well as stereoacuity (Pvalues: 0.04 and 0.03, respectively). Intraocular pressure (IOP) decreased significantly from 29.79 ± 7.67 mmHg at baseline to 16.13 ± 3.41 mmHg at the final follow-up (P = 0.001).

Patients with PCG can achieve an acceptable visual acuity and stereoacuity, particularly in cases of timely intervention and close follow-up.

To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation for glaucomatous eyes in short, intermediate, and long term follow up periods.Patients and

  In this retrospective study 76 eyes of 76 patients who underwent AGV insertion in Imam Hossein Medical Center, Tehran, Iran, between January 2008 and March 2017 with at least three years of followup were included. At each visit complete ophthalmic examination was performed and the success rate of surgery was assessed. Surgical success  was defined  as  5 ≤ IOP ≤ 21  mmHg  and  at  least  20 %  reduction  in  IOP without any glaucoma medication (complete success), or with the use of anti glaucoma medication (qualified success). The sum of complete and qualified success was reported as cumulative success.

The mean age of patients was 53.18 ± 16.92 years and the mean duration of follow up was 3.27 ± 2.36 years (range: 1-5 years). The complete surgical success rate was 20 % at 1 year, 18 % at 2 years, 16 % at 3 years, 15 % at 4 years, and 8 % at 5 years of followup and there was no medication free patient at more than 5 years followup. The cumulative success rate was 91 %, 88 %, 84 %, 80 %, and 77 % at 1 to 5 years of followup respectively.

Ahmed glaucoma valve (AGV) implantation for glaucomatous eyes results in acceptable IOP reduction and less medication need in short, intermediate, and long term follow up periods.Key words: Glaucoma; Intraocular pressure; Ahmed glaucoma valve; Treatment outcome.

Trabeculectomy with mitomycin-C remains the gold standard for surgical glaucoma management; however, this technique includes some sight-threatening complications like avascular thin bleb, subsequent leakage and ultimately endophthalmitis. To date, various non surgical methods have been reported for the management of bleb leakage, but surgical management frequently becomes necessary especially in frank leakages. The most common surgical approach includes excision of the avascular and necrotic leaking bleb combined with the advancement of adjacent healthy conjunctiva. The aim of the present review is to discuss avascular bleb and late bleb leakage after trabeculectomy including their histopathology, risk factors, prevention and management.

Corneal collagen cross-linking (CXL) has become the standard initial intervention in eyes with progressive keratoconus (KC) that have not undergone keratoplasty. The prolonged exposure of the de-epithelialized cornea predisposes it to adverse complications, such as microbial keratitis and melting. Herein, we report a case of bilateral recurrent peripheral stromal keratitis following CXL. We present a 29-year-old woman who complained of ocular redness and discomfort in both eyes for 4 months, and had undergone bilateral CXL 10 months before. The best spectacle corrected visual acuity (BSCVA) was 60/200 in the right and 80/200 in the left eye. Both eyes showed moderate conjunctival hyperemia, dilation, and engorgement of the perilimbal episcleral vessels. There was a peripheral corneal stromal infiltration with thinning, and an overlying epithelial defect in the right eye with a lucid interval from the limbus. She was treated with lubricating eye drops and ointments and topical corticosteroids every 4 hours for 2 weeks then slowly tapered off. Afterwards, she experienced multiple recurrences in both eyes, which were successfully managed with topical corticosteroids and lubricants. After 2 years, her BSCVA was 20/30 with −3.00-5.50 * 90 in the right eye and 20/40 with −4.00-4.50 * 90 in the left. Although CXL is a safe method, studies with longer follow-ups are needed to investigate the risk of rare complications.

Investment in science is vital for the development and well-being of societies. This study aims to assess the scientific productivity of countries by quantifying their publication of systematic reviews taking the gross national income per capita (GNIPC) into account. Medline and ISI Web of Science were searched for systematic reviews published between 1st January 2006 and 31st December 2010. The productivity of each country was quantified by exploring the authors’ affiliation. The GNIPC was used according to the World Bank Report. Concentration index (CI) was calculated as the index of inequality. CI of percentage of systematic reviews as a function of percentage of countries ranked by GNIPC was 0.82 which indicates inequality in production of systematic reviews in pro rich countries. Countries with high income produced 206.23 times more systematic reviews than low income countries, while this ratio for lower middle and upper middle countries was 9.67 and 12.97, respectively. The highest concentration index was observed in clinical sciences (0.76) and the lowest in public health (0.61). This study demonstrates a significant gap between industrialized and non-industrialized countries in the production of systematic reviews. Addressing this gap needs tremendous national and international efforts.

Sonoelastography (SE) is introduced as a complementary technique for ultrasoungraohy (US) to evaluate breast lesions. This method is based on tissue strain in response to compression and decompression. The current study was designed to investigate the diagnostic performance of SE for differentiating between benign and malignant breast lesions A total of 35 women with 45 breast lesions who were referred to a university affiliated hospital in Tehran were enrolled. All patients were visited and examined by a same radiologist. A five-point scale was applied for categorizing lesions in SE as malignant or benign. The results of US and SE were compared with histopathological results to calculate sensitivity and specificity of each mentioned techniques. Histopathological evaluations in 12 cases were in favor of malignancy, and the rest of cases were classified as benign. The sensitivity and specificity for US were 100% and 69.7%, respectively. On other hand, SE obtained a lower sensitivity (58.3%) and higher specificity (90.9%) in comparison with US. simultaneous evaluation of suspicious breast lesions with both US and SE can have high sensitivity and specificity and prevent the unnecessary invasive interventions.