فهرست مطالب reza soltani moghadam

Ocular trauma is a debilitating condition and one of the most important and leading causes of visual impairments that have high socioeconomic consequences.

This study aims to investigate the epidemiology of ocular trauma in patients referred to a tertiary center in northern Iran.

This cross-sectional study was carried out on 476 patients with ocular trauma referred to the eye emergency department of a teaching hospital in Guilan Province, north of Iran, in 2020-21. Personal and trauma-related information was extracted from the patient’s medical records using a checklist. 

Most patients were in the 31-40 age group (28.8%), with a mean age of 41.5±17.4 years. Most of the injuries occurred at home (57.1%). Few of the patients had used eye safety glasses (5.3%). Most of the patients were living in the city. Closed globe injuries were the common types of traumas (96%), and the prevalence of open globe injuries was at a very low level (4%).

Closed globe injuries are the most common types of ocular traumas in northern Iran. Most of the ocular traumas are preventable using eye protection equipment.

In the education process, instructors and students are in constant interaction with each other. Faculty members play a significant role in students’ education process. This study aimed to explain the concept of competency among faculty members of Guilan University of Medical Sciences.

In this qualitative study, using the content analysis method, 16 faculty members of Guilan University of Medical Sciences in 2018 who were willing to participate in the study were selected through the purposive sampling method. Data were collected through semi-structured interviews, and their experiences and viewpoints were surveyed until data saturation was reached.

In this study, five categories were extracted: individual characteristics, individual skills, scientific knowledge, using new technologies, and receiving internal and external organizational support. Furthermore, ‘The competent faculty member: a perfect human with all qualifications necessary for education’ emerged as the main theme.

Based on the results, faculty members considered all the necessary qualifications for a professor in the education process as the criteria for competency. Consideration of the qualifications stated by the faculty members can help the managers and those involved in the field of education in enhancing and promoting faculty members’ competency. The results of this study can be used as enlightenment for further studies in this field.

In the present study, we investigated the effect of two doses of atropine eye drops versus placebo on myopia progression in children and adolescents.

In this double‑blind, randomized clinical trial, 67 patients aged 6 to 18 years with myopia of ‑2 to ‑6 D were enrolled and randomized to receive a placebo eye drop, atropine 0.1%, or 0.01% ophthalmic solution (one drop per night for 6 months). All participants were followed‑up with for one year after the beginning of the study (at zero, one, three, six, and 12 months) and their spherical equivalent (SE), axial length (AL), anterior chamber depth (ACD), and far and near visual acuity (VA) and the eye drops side effects were recorded. A comparison among the groups was performed using SPSS software, version 24.0.

Spherical equivalent, AL, and ACD decreased and far VA improved in atropine groups to a greater extent than the placebo group (P < .05) at the 6‑month follow‑up. The most common side effects of atropine 0.1% eye drop included photophobia and decreased near VA. At the end of the study (six months after the cessation of atropine), a rebound effect was observed; this effect was especially severe in the 0.1% atropine group.

Atropine eye drops are effective for slowing down and preventing myopia progression. However, without long‑term treatment, they will have a rebound effect. A lower dose (0.01%) is suggested for reducing the side effects and rebound effects.

To assess the longitudinal changes of choroidal thickness using enhanced depth imaging optical coherence tomography (EDI‑OCT) during pregnancy and postpartum.

The study included 23 eyes of 23 healthy pregnant women and 23 eyes of 23 healthy nonpregnant women. Choroidal thickness 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 postpartum and in the follicular phase of the menstrual cycle for the control group.

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 postpartum, respectively. In all seven measured locations, statistically significant changes were noted during pregnancy and postpartum in the choroidal thickness (P < 0.001). Choroidal thickness increased from the first trimester to the second and third trimester, after which it decreased at postpartum. Choroidal thickness was greater in the pregnant group during pregnancy and postpartum compared to the control group (P < 0.001).

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 nonpregnant subjects.

 Keratoconus (KCN) is a bilateral, progressive, and non-inflammatory disorder in the cornea, which results in thinning and protrusion of the cornea.

 This study aims to determine the effectiveness of using pachymetric progression indices (PPIs) in grading the severity of KCN disease. 

In this study, 76 patients with different stages of KCN were enrolled. The severity of KCN was graded according to maximum keratometry, cornea thickness, and spherical equivalent. The PPIs measured by Pentacam and the demographic characteristics were recorded and their correlation with the severity of KCN was assessed.

 In terms of KCN severity, 18% of patients were at grade 1, 31% at grade 2, 42% at grade 3, and 7% at grade 4. The power of PPIs in predicting KCN grade 4, grade 3 and grade 2 based on the area under the curve ranged from 0.722 to 0.993. 

 The PPIs (Minimum, Maximum, Average) can predict the severity of KCN disease with good sensitivity and specificity.

To evaluate the efficacy of 3‑month administration of topical cyclosporin A(CsA) 0.05% on postoperative recurrence after pterygium surgery.

In this randomized clinical trial, 78 patients undergoing pterygium surgery (using the rotational conjunctival flap technique with mitomycin C [MMC]) were enrolled and randomly allocated into the control (n = 39) and case (CsA) (n = 39) groups in a single‑blind method. The patients were examined on postoperative days 1, 3, and 7 and months 1, 3, and 6, and their best‑corrected visual acuity, intraocular pressure, clinical inflammation, postoperative complications, and recurrence were compared.

The mean age of patients was 53.22 ± 9.99 years; most (57.7%) of them were men. The two groups were not different in terms of demographics, pterygium size, or pterygium grade. The clinical inflammation at the first and third postoperative months was not different between the groups(P = 0.108 and 0.780, respectively). No serious complications were detected; complication rates were not different between the groups (P = 0.99). The recurrence rate was 5.1% in the case group and 7.7%% in the control group (P = 0.99).

The present study showed no priority for 3‑month administration of CsA 0.05% drops on postoperative outcomes, including prevention of pterygium recurrence, complications, and inflammation after the rotational conjunctival autograft technique with MMC.

To present a case of linear scleroderma known as “en coup de sabre” associated with Coats’- like response.

A 12-year-old boy presented with subacute painless vision loss in the ipsilateral side of the patient’s en coup de sabre lesion. Ocular examination revealed vitreous hemorrhage with severe exudation of the posterior pole and telangiectatic vessels. Fundus fluorescein angiography indicated multiple vascular beadings and fusiform aneurysms with leakage which was consistent with a Coats’-like response. The patient was subsequently treated with intravitreal bevacizumab and targeted retinal photocoagulation. Twelve months’ follow-up showed marked resolution of macular exudation with significant visual improvement.

Physicians should be aware of the possible ophthalmic disorders accompanying en coup de sabre and careful ophthalmologic examinations should be performed in these patients. As presented in the current case, treatment with intravitreal anti-VEGF agents and laser photocoagulation may be a beneficial option for patients with coats’-like response.

To determine the benefits of performing preoperative spectral domain optical coherence tomography (SD‑OCT) and to identify occult macular pathologies in patients scheduled for routine cataract surgery.

In this cross-sectional study, macular SD-OCT scans were performed on all patients with clinically undetected macular abnormalities who were scheduled for cataract surgery. Patients with clinically evident macular abnormalities were excluded from the study. A retinal specialist reviewed all the scans. The severity of the cataract was determined using the Oxford Clinical Cataract Classification and Grading System.

Of the 598 evaluated cases, 33 patients (5.52%) had an occult macular abnormality. The most common pathology found in these patients was idiopathic epiretinal membrane, which was detected in 17 eyes (51.52%), followed by vitreomacular traction in nine eyes (27.27%), and dry age‑related macular degeneration in four eyes (12.12%). Full‑thickness macular holes and a lamellar macular hole were found in two patients (6.06%) and one patient (3.03%), respectively. The frequency of cortical cataracts was significantly lower in patients without macular lesions (P = 0.012) than in those with macular lesions. Multivariate logistic regression analysis revealed that age >70 years (P = 0.025 and odds ratio [OR] =11.12), smoking history (P = 0.043 and OR = 3.43), and hypertension were independently associated with occult macular lesions. The surgical plan was changed for five patients (0.83%).

Macular SD-OCT can be used to detect occult macular lesions and provide useful information about a macula before cataract surgery. Although preoperative OCT found macular abnormalities in about 5% of patients with presumed normal fundus examination, it can result in changing the surgical plan in 0.83% of all patients.

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).

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.

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).

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.

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.

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 two 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.

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.

Inherited metabolic disorders (IMDs) are a class of genetic disorders. Each metabolic disorder may have different forms with different age of onset, clinical manifestations, severity, and even type of inheritance. Ideally, a group of different specialists, including ophthalmologists, pediatricians, biochemists, and medical geneticists are needed for the final diagnosis and management of IMDs. Because of the importance of the aforementioned issue, we investigated the effect of IMDs on the eye in this review. Metabolic disorders can induce abnormalities in conjunctiva, cornea, lens, retina, optic nerve, and eye motility.  In this study, the authors aimed to address the effect of metabolic diseases of amino acids, carbohydrates, and lipids on eye metabolism. Because of the direct toxic mechanisms of abnormal metabolites on the eyes and regarding the effect of eye monitoring on follow-up, management, and treatment of IMDs, a detailed ophthalmological assessment is essential.

This study investigates the effects of 0.05% topical tacrolimus as an adjunct therapy for patients with non-necrotizing herpetic stromal keratitis (HSK).

Patients with non-necrotizing HSK, referred to the Cornea Clinic at Hospital in Rasht, Iran, between September 2016 and February 2018, were randomly assigned to two groups. The case group (N = 25) and the control group (N = 25) received conventional treatment with systemic acyclovir and topical prednisolone. The case group (N = 25) additionally received 0.05% tacrolimus eye drops four times a day for one month. Complete ocular examinations, including best-corrected visual acuity (BCVA) assessment, intraocular pressure (IOP) measurement, slit lamp biomicroscopy, and photo slit lamp imaging, were performed before treatment, and 3, 7, 14, 21, and 28 days after the intervention.

The mean age of the patients was 46.2 ± 12.9 years, and 70% of the patients were male. There was no difference between the groups in terms of age, sex, and baseline ocular measurements (P > 0.05). The case group had a lower mean logarithm of the minimum angle of resolution (LogMAR) for BCVA, lower grading scores, and steeper decreasing trends for corneal haziness, edema, neovascularization, and epitheliopathy compared to the control group after the second week (P < 0.05), while IOP remained unchanged between groups (P > 0.05).

The addition of 0.05% topical tacrolimus enhances visual acuity and reduces corneal inflammation, neovascularization, and scarring; thus, it can used as an appropriate adjunct treatment for patients with HSK.

Topical anesthesia (TA) may accompany more discomfort for some patients during cataract surgery. We aimed to evaluate the potential factors that can be used for predicting patient’s cooperation during phacoemulsification surgery under TA. One hundred sixty consecutive cases that were candidate for phacoemulsification surgery were enrolled in this prospective study. Patients’ sex, age, place of residence (urban or rural), education level (literate and illiterate) and physical examination variables (visual acuity, reaction to eye drop, cooperation during tonometry, and reaction to press on the lacrimal sac before surgery) evaluated. Patients’ cooperation during surgery was classified as successful (good and satisfactory) or failed (weak) groups. In this study, 103(64.4%) cases showed good or satisfactory cooperation, and others had weak cooperation. There was no correlation between patients’ cooperation during surgery and sex (P=0.2), age (P=0.7), place of residency (P=0.3), and education level (P=0.3). The successful group showed a higher rate of non-reaction to eye drop (P=0.0001), good cooperation during tonometry (P=0.0001), non-reaction to press on lacrimal sac (P=0.0001), and lower visual acuity (P=0.045). In the multi-logistic regression, non-reaction to eye drop (OR=66.4), good cooperation during tonometry (OR=21.2, good vs. bad and OR=7.2, satisfactory vs. bad), lower visual acuity (OR=7, <0.1 vs. 0.1-0.4 d) are the significant predictors for the success of TA. This study showed that some ocular examination tests before surgery (visual acuity, reaction to eye drop, cooperation during tonometry, and reaction to press on the lacrimal sac) could predict patients’ cooperation during phacoemulsification surgery under TA.

To evaluate the correlation of corneal elevation and difference elevation with severity of keratoconus.

Anterior and posterior corneal elevations with both conventional and enhanced best-fit spheres (using rotating Scheimpflug camera) were measured. Front and back difference elevation were extrapolated from difference map of Belin/Ambrỏsio Enhanced Ectasia Display of the Scheimpflug system. Data from corneal elevations and difference elevations were correlated with maximum keratometry, minimal corneal thickness, and severity of keratoconus as assessed by Amsler-Krumiech classification of keratoconus.

Ninety eyes of 55 keratoconus patients of different clinical stages were evaluated. There was a significant positive correlation between keratoconus severity and corneal elevations (anterior and posterior elevation as measured with both conventional and enhanced best-fit spheres) and also between keratoconus severity and corneal elevation differences (P < 0.001 and r > 0.625 for all). Maximum keratometry (Kmax), mean keratometry (Kmean), and all corneal elevations and difference elevations were highly correlated (P < 0.001 and r > 0.840 for all). A significant negative correlation was found between minimum corneal thickness and all corneal elevations and difference elevations (P < 0.001 and r < 0.711 for all). Receiver operating characteristic (ROC) curve analyses showed that anterior and posterior difference elevations have the best predictive accuracy for grading keratoconus severity.

Evaluation of corneal elevation and difference elevation data obtained from Scheimpflug corneal imaging is useful for grading severity of keratoconus.

Topical anesthesia (TA) may accompany with more discomfort for some patients during cataract surgery. We aimed to evaluate the potential factors that can be used for predicting patient’s cooperation during phacoemulsification surgery under TA.

One hundred sixty consecutive cases that were candidate for phacoemulsification surgery enrolled in this prospective study. Patient characteristics including sex, age, place of residence (urban or rural), education level (literate and illiterate) and physical examination variables  including visual acuity in logarithm of minimum angle of resolution (LogMAR), reaction to eye drop, and cooperation during tonometry before surgery were evaluated. Patient cooperation during surgery was classified into successful (good and satisfactory) or failed (weak) cooperation. The two groups were compared in terms of baseline and clinical examination variables.

In this study, 103(64.4%) cases showed a good or satisfactory cooperation, and others had a weak cooperation. There was no association between patient cooperation during surgery and sex (P-value = 0.2), age (P-value = 0.7), place of residence (P-value = 0.3) and education level (P-value = 0.3). The successful group showed a higher rate of non-reaction to eye drop (P-value = 0.0001), good cooperation during tonometry (P-value = 0.0001), non-reaction to press on lacrimal sac (P-value = 0.0001), and lower visual acuity (P-value = 0.045). In the multivariate logistic regression model, non-reaction to eye drop (OR = 66.4), good and satisfactory cooperation during tonometry (OR = 21.2, OR = 7.2, respectively) compared to weak cooperation, lower LogMAR of visual acuity (OR = 7) were significantly associated with the success of TA.

This study showed that some ocular examination tests before surgery including visual acuity, reaction to eye drop, cooperation during tonometry and reaction to press on the lacrimal sac can predict patient cooperation during phacoemulsification surgery under TA.

This study was conducted to determine the demographics, clinical features, severity, and activity of thyroid eye disease (TED) in patients of a referral center in the north of Iran. Patients with TED who were referred to Amir-Almomenin Hospital, Rasht, Iran from March 2012 to March 2014 were enrolled in this cross-sectional study. The measurements of proptosis, lid width, lagophthalmos, extraocular muscle function, and visual acuity were recorded. The activity of ophthalmopathy was scored according to the clinical activity score (CAS). TED was diagnosed in 103 patients with a mean age of 42.1 ± 13.91 years. Of those patients, 52.4% were women, and 80% had hyperthyroidism. The mean duration of TED was 36.5 ± 53.12 months. Extraocular muscle involvement (98%) and eyelid retraction (88.3%) were the most common manifestations. Per the CAS results, 86 (83.5%) patients were at stage 0, and there was a significant difference in CAS scores between male and female patients, P = 0.02. The characteristics of TED in patients of the studied referral center during a two-year period, including common signs and symptoms, disease duration, treatment, an activity of disease were determined. Notably, many patients in this study had orbital squeal of TED meaning that they had inactive TED. Proper management of this serious complication requires close cooperation between endocrinologists and ophthalmologists to ensure timely referrals for appropriate care.

PurposeTo compare the recurrence rate and surgical outcomes of amniotic membrane transplantation (AMT) and free conjunctival autograft (CAT) for pterygium surgery.
MethodsIn this prospective study, 60 patients with primary pterygium were randomly assigned to two groups of CAT or AMT and were compared in terms of recurrence rate, mean healing time of corneal epithelial defects, the mean level of inflammation, and complications.
ResultsThe mean ± SD age of patients was 48.98 ± 9.8 years (range, 27–71 years). 73.3% were men, and 26.7% were women. The groups did not differ with respect to demographic characteristics (P > 0.05). Patients were followed for an average of 12.6 ± 1.3 months. The recurrence rates were 6.7% and 3.3% in the AMT and CAT groups, respectively (P > 0.05). Comparison of mean inflammation score showed higher inflammation in the AMT group in the first, third, and sixth postoperative month (P ConclusionsNo significant complication was observed during or after both surgical methods. No statistically significant difference was seen in visual acuity changes and epithelial healing in CAT and AMT groups, but more inflammation and recurrence rate were seen in AMT group.

To report the incidence and risk factors for retinopathy of prematurity (ROP) among preterm infants referred to Amiralmomenin Eye Hospital, Rasht, Iran.
This cross-sectional retrospective study included all preterm infants with birth weight ≤2500 g and/or gestational age ≤36 weeks who had been referred to our facility for ROP screening over a five year period from September 2005 to September 2010. Possible risk factors and findings related to eye examinations were extracted and analyzed.
Among 310 infants, ROP was diagnosed in 64 (20.6%) of referred preterm infants (95% CI: 17.7%‑23.5%); these included stage I in 48%, stage 2 in 29%, and stage 3 or higher disease in 23% of subjects. Mean gestational age (GA) and birth weight (BW) in the ROP–affected infants was 30.18 ± 2.28 weeks and 1,422.8 ± 420.8 g, respectively. Low BW, low GA, oxygen therapy, phototherapy, blood transfusion and apnea were risk factors for ROP. After logistic regression analysis, only low GA and low BW were independently associated with the condition.
ROP is a relatively common finding in preterm infants of Guilan Province in the North of Iran. Low BW and low GA were significant risk factors for the disease.

Congenital nasolacrimal duct obstruction (CNLDO) is a common disease in children. The classic treatment of CNLDO is probing that was done around one year old. However, controversy exists regarding the outcome of probing in children older than one year. This study aimed to find the cure rate of initial probing for CNLDO and identify factors producing the failure rate in old age. In this retrospective interventional case series study, 100 eyes of 92 patients aged 9-48months with CNLDO underwent probing with general anesthesia. According to the intraoperative results of probing, CNLDO were categorized in two groups of membranous obstruction at the end of nasolacrimal duct obstruction (NLD) and complex obstruction at canaliculus, lacrimal sac and N LD. Patients were categorized in three groups according to the age of probing into under 12, 12 to 24 and over 24 months. Success rate was defined as successful irrigation of NLD intraoperatively and absence of lacrimation and discharge at 1week, one, three and six months postoperatively. The average age of patients and probing were 47.35±25.59 and 17.32±7.85 months respectively. Membranous obstruction accounted for 72% of patients and remainder had complex type. An overall cure rate of 91%, 89% and 60% was found in patients aged 9-12, 12-24 and 24-48 months respectively. Surgery success rate after six months was 91% in membranous group and 52% in complex group. There was a significant relation between the type of obstruction and opening of NLD (p<0.O01). This study showed that the probing failure of probing after one year was related to the complexity of obstruction rather than the age of the patient. It is recommended that probing could safely be done in under 4years old.

To evaluate intraocular pressure (IOP) and anterior chamber depth (ACD) change after phacoemulsification with posterior chamber intraocular lens implantation In this quasi-experimental study, 84 patients with senile cataract were included. All patients had normal IOP. Patients with traumatic and complicated cataract, any history of uveitis, glaucoma, or other ocular disease or surgery were excluded. Patients underwent phacoemulsification and intraocular lens implantation by the same surgeon. IOP, ACD, and lens thickness were measured and recorded before surgery. IOP was measured at 4, 8 and 12 postoperative weeks and ACD was measured 12 weeks after surgery. The mean preoperative ACD significantly increased from 2.93 mm to 3.54 mm postoperatively (p<0.0001). Mean preoperative IOP was 16.06 mmHg which decreased to 12.01 IOP mmHg, 12.57 mmHg and 12.90 mmHg at 4 weeks, 8 weeks and 12 weeks postoperatively, respectively (all p-values<0.0001). There was a correlation between lens thickness and changes of and ACD after the surgery. There was also a positive correlation between preoperative IOP and IOP reduction after the surgery. Phacoemulsification decreases IOP specially in eyes with higher preoperative IOP and thicker lenses.

To evaluate the effect of topical diclofenac sodium 0.1% on the corneal epithelial healing after photorefractive keratectomy (PRK) In this prospective randomized double blind clinical trial, PRK was performed on 82 patients. Thirty-three cases of them receiving topical diclofenac four times per day after surgical procedure and 45 patients did not receive this medication as a control group. Patients were compared for corneal epithelial healing after treatment. Statistically significant delayed epithelial healing has been found in the treatment group 24 hours after PRK but corneal reepithelialization has been completed in all patients four days after surgery. Postoperative topical diclofenac used following PRK may delay the epithelial healing.

To report a case of bilateral dense ring-shaped marginal keratitis after photorefractive Keratectomy (PRK) Case report : A 44-year-old man developed bilateral dense ring-shaped marginal keratitis after PRK. The patient had moderate to severe meibomian gland dysfunction preoperatively that was treated incompletely. He was treated with mild topical antibiotics, topical and systemic steroids and systemic doxycycline. The condition was controlled with faint peripheral scarring. This case suggests the role of blepharitis and meibomian gland dysfunction in producing marginal keratitis after excimer laser for which complete preoperative treatment is recommended.

To report the outcomes of goniotomy in young children with primary congenital glaucoma. This retrospective study included 26 eyes of 19 patients with primary congenital glaucoma who underwent goniotomy as the initial procedure. All patients were aged less than 3 years and had no history of previous ocular surgery. The main outcome measures were intraocular pressure (IOP), cup/disc (C/D) ratio, corneal diameter, success rate and complications. Surgical success was defined as IOP less than 20 mmHg (with or without medications) without progression of disc cupping or increase in corneal diameter. Mean age at the time of diagnosis was 10.5±12.2 (range 0-36, median 7.5) months. Mean follow-up period was 19.3±18.3 (range 2-62, median 12) months. Preoperatively, 20 eyes (76.9 %) had corneal edema. Mean corneal diameter was 13.60±0.99 mm (range 12-16 mm) preoperatively which reached 13.98±1.08 mm (range 12-16 mm) at last follow-up (P=0.174). Mean IOP was 27.74±6.07 (range 17-44) mmHg pre-operatively which decreased to 24.44±7.88 (range 11-40) mmHg at final follow-up (P=0.048). Surgical success after the first goniotomy was 34.6%. The age of onset, level of IOP, C/D ratio, corneal clarity and corneal diameter did not significantly affect the surgical outcome. There was small hyphema in all patients postoperatively, which resolved rapidly in all except one who required surgical evacuation. Goniotomy is a safe and relatively effective procedure in young children with primary congenital glaucoma, but the success rate was low in our study; which can be attributed to the greater severity of the disease.