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Ophthalmic and Vision Research - Volume:16 Issue: 1, Jan-Mar 2021

Journal of Ophthalmic and Vision Research
Volume:16 Issue: 1, Jan-Mar 2021

  • تاریخ انتشار: 1399/11/28
  • تعداد عناوین: 22
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  • Zahra-Soheila Soheili*, Hamid Latifi-Navid Pages 1-2
  • Ahmed Nishat H*, Gita Satpathy, Rohan Chawla, Radhika Tandon Pages 3-11
    Purpose

    Most common viruses causing ocular infections are Herpes Simplex Viruses (HSV) type 1 and type 2, Cytomegalovirus (CMV), Varicella-zoster Virus (VZV), and few strains of Adenovirus. Diagnosis of these infections through clinical manifestations and using conventional methods has a number of limitations. The purpose of this study was to develop a multiplex Polymerase Chain Reaction (PCR) for simultaneous detection of all pathogenic viruses from ocular infections.

    Methods

    Ten uniplex PCRs were standardized, two each for HSV type 1 (HSV-1) and type 2 (HSV-2), CMV, VZV, and Adenovirus. Various multiplexing combinations of above PCRs were put to finalize targets and reaction conditions enabling diagnosis of all in a single reaction. The uniplex and multiplex PCRs were run for known positive and negative controls, and samples from clinically suspected patients and healthy controls.

    Results

    Out of the 170 samples from suspected ocular infections, 24.7% were positive by uniplex PCR and 22.9% were correctly identified by multiplex PCR. None of the samples negative by uniplex PCRs was positive by the multiplex PCR. The sensitivity and specificity of multiplex PCR compared to the commonly used uniplex PCRs as gold standard was 92.86% and 100%, respectively. The prevalence of different viral pathogens was 13.5% for HSV-1, followed by 5.9% for Adenovirus, 2.4% for VZV, 1.8% for HSV-2, and 1.2% for CMV.

    Conclusion

    The establishment of multiplex PCR has found immediate application in diagnosing ocular viral pathogens in a single reaction, thus saving time, manpower, and resources by fivefold.

    Keywords: Adenovirus, Cytomegalovirus, Herpes Simplex Virus, Multiplex Polymerase ChainReaction, Varicella-zoster Virus
  • Zahra Karjou, Mohammad-Reza Jafarinasab*, Mohammad-Hassan Seifi, Kiana Hassanpour, Bahareh Kheiri Pages 12-20
    Purpose

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

    Methods

    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.

    Results

    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.

    Conclusion

    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.

    Keywords: Residual Ametropia, Intraocular Lens Implantation, Piggyback IOL Implantation
  • Jonathan B. Lin, Arsham Sheybani, Andrea Santeford, Rajendra S. Apte* Pages 21-27
    Purpose

    Growth Differentiation Factor 15 (GDF15) was previously identified as a molecular marker of retinal ganglion cell stress in rodent models of glaucoma and was elevated in the aqueous humor (AH) of patients with primary open-angle glaucoma as a possible risk factor for glaucoma progression. The purpose of this study was to determine whether changes in the AH GDF15 levels were associated with intraocular pressure (IOP) changes in eyes undergoing glaucoma surgery.

    Methods

    Here, we performed a prospective, longitudinal pilot study in nine patients to determine whether changes in AH GDF15 levels from surgery to post-surgery follow-up were associated with IOP fluctuation. An initial AH sample was taken from the peripheral corneal paracentesis during planned glaucoma surgery, and a second sample was taken during an outpatient follow-up visit, approximately six months later.

    Results

    There was a statistically significant correlation between GDF15 fold change and IOP standard deviation (r = 0.87, P = 0.003), IOP range (r = 0.87, P = 0.003), and maximum IOP (r = 0.86, P = 0.003). There was no correlation between the GDF15 fold change and baseline IOP (r = 0.50, P = 0.17), final IOP (r = 0.038, P = 0.92), or mean IOP (r = 0.40, P = 0.28).

    Conclusion

    Our findings in this pilot study suggest that longitudinal changes in AH GDF15 may be associated with IOP fluctuation during the postoperative period. Further studies are necessary to corroborate these findings in a larger patient population and to explore the possibility that AH GDF15 may be used not only to improve treatment algorithms but also as a surrogate endpoint in clinical trials.

    Keywords: GDF15, Glaucoma, Neurodegeneration, Molecular Markers
  • Ahmad Mirshahi, Alireza Lashay, Hamid Riazi-Esfahani, Nazanin Ebrahimiadib, MDHassan Khojasteh, Fariba Ghassemi, Fatemeh Bazvand, Alireza Khodabande, Ramak Roohipour, Elias Khalili Pour, Hooshang Faghihi* Pages 28-33
    Purpose

    To report the results of intravitreal injection of a bevacizumab biosimilar called Stivant®.

    Methods

    This prospective interventional case series was conducted on eyes with neovascular age-related macular degeneration (nAMD), retinal vein occlusion (RVO), and diabetic macular edema (DME). Stivant® was injected in three consecutive months and changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and monthly up to one month after the third injection.

    Results

    Three hundred and eighty-five eyes with DME (234 eyes, 61%), nAMD (87 eyes, 22%), and macular edema secondary to RVO (64 eyes, 17%) were enrolled. The mean ± standard deviation age of the patients was 61.7 ± 7.20 years. The mean BCVA and CMT changed from 0.63 ± 0.3 to 0.51 ± 0.3 LogMAR (P = 0.12 ) and from 420.4 ± 47.3μm at baseline to 316.7 ± 50.6 μm (P < 0.001) in the DME group; from 0.79 ± 0.3 to 0.68 ± 0.3 LogMAR (P = 0.19) and from 376.1 ± 31.7 μm to 303 ± 31.3 μm (P = 0.019) in the nAMD group; and from 0.81 ± 0.4 to 0.63 ± 0.4 LogMAR (P = 0.05) and from 424.21 ± 18 μm to 303.4 ± 18.8 μm (P < 0.001) in the RVO group, respectively.

    Conclusion

    Our limited experience showed that the intravitreal injection of Stivant® was well tolerated. Although the results of this case series showed relative improvement in CMT one month after the last injection of Stivant®, BCVA improvement was statistically significant only in the RVO group. This would be essential to design a randomized clinical trial to evaluate the non-inferiority of Stivant® in comparison to bevacizumab.

    Keywords: Stivant®, Bevacizumab, Anti-VEGFs, Anti-vascular Endothelial Growth Factors, Diabetic MacularEdema, Retinal Vein Occlusion, Neovascular Age-related Macular Degeneration
  • Saeed Karimi*, Vahid Movafaghi, Amir Arabi, Toktam Shahraki, Sare Safi Pages 34-41
    Purpose

    To assess the effects of oral vitamin D supplement therapy on clinical outcomes of intravitreal bevacizumab (IVB) injections in patients with diabetic macular edema (DME).

    Method

    Seventy-one patients with center-involving DME received IVB injections three times monthly. Cases with serum 25-hydroxyvitamin D (25(OH)D) levels <30 ng/ml were divided into treatment and control groups. The treatment group received 50000 IU of oral vitamin D once a week for eight weeks. One month after the third IVB injection, changes in the best-corrected visual acuity (BCVA) and central macular thickness (CMT) were analyzed for each group.

    Results

    Thirty-seven patients had sufficient levels of 25 (OH) D, while 34 patients had insufficient levels. Nineteen cases with deficient levels of 25(OH)D were treated with oral vitamin D, while 15 patients were assigned to the control group. The mean of serum 25(OH)D in patients was 27.9 ng/ml [mean 20.3 ± 5.4 and 17.3 ± 5.4 ng/ml in control and treatment groups, respectively (P = 0.231)]. After three IVB injections, BCVA improved significantly in each group, but the difference between the study groups was not statistically significant. CMT decreased significantly in all the groups. The mean CMT reduction was more prominent in the vitamin D-treated group, but the difference between groups did not reach statistical significance (P = 0.29).

    Conclusion

    In DME patients with vitamin D deficiency, vitamin D supplement therapy had some beneficial effects on CMT reduction following three injections of IVB; nevertheless, these effects were not statistically significant. Definite conclusion needs further prospective studies with a larger sample size.

    Keywords: 25-Hydroxyvitamin D, Insufficiency, Diabetic Macular Edema, Intravitreal Bevacizumab
  • Brian C. Joondeph*, Paul Willems, Thomas Raber, Luc Duchateau, Joseph Markof Pages 42-55
    Purpose

    To assess the effect of patient baseline characteristics on the efficacy of ocriplasmin treatment for symptomatic vitreomacular adhesion (VMA) with full-thickness macular hole (FTMH) from phase 3/4 studies.

    Methods

    Patients with symptomatic VMA and FTMH at baseline and receiving ocriplasmin treatment 125 𝜇g were pooled from the MIVI-TRUST, OASIS, and ORBIT studies. Multivariable logistic regression analysis was used to evaluate whether patient baseline characteristics were predictors of having VMA resolution by Day 28 and FTMH closure by Month 6.

    Results

    Two hundred and seventy-four patients receiving ocriplasmin treatment were assessed. Overall, 22.6% (62/274) of the patients experienced both VMA resolution by Day 28 and non-surgical FTMH closure by Month 6. Patients with FTMH ≤250 µm at baseline had a significantly higher success rate compared to those with FTMH >400 µm (29.9% [41/137] vs 2.2% [1/48]; P = 0.009). In patients with VMA resolution by Day 28, both small FTMH size (P = 0.001) and FTMH width at RPE (P = 0.012) were significantly associated with a higher FTMH closure rate. Patients with VMA resolution had higher rates of FTMH closure. Previously identified baseline predictive factors, including age, lens status, or presence of epiretinal membrane (ERM) were not found to be predictive of both VMA release and FTMH closure.

    Conclusion

    The analysis revealed that FMTH ≤250 µm was the only factor predictive for achieving both pharmacological VMA resolution by Day 28 and nonsurgical FTMH closure by Month 6; neither lens status or presence of ERM, previously identified baseline characteristics favoring VMA resolution, showed statistically significant predictive power for both outcomes.

    Keywords: Ocriplasmin, Full-thickness Macular Hole, Vitreomacular Adhesion, SymptomaticVitreomacular Adhesion, Vitreomacular Traction, Vitreoretinal Interface
  • Nima Beheshtizadeh, Alireza Baradaran-Rafii, Maryam Sharifi Sistani, Mahmoud Azami* Pages 56-67
    Purpose

    Considering the significance of retinal disorders and the growing need to employ tissue engineering in this field, in-silico studies can be used to establish a cost-effective method. This in-silico study was performed to find the most effective growth factors contributing to retinal tissue engineering.

    Methods

    In this study, a regeneration gene database was used. All 21 protein-coding genes participating in retinal regeneration were considered as a protein–protein interaction (PPI) network via the “STRING App” in “Cytoscape 3.7.2” software. The resultant graph possessed 21 nodes as well as 37 edges. Gene ontology (GO) analysis, as well as the centrality analysis, revealed the most effective proteins in retinal regeneration.

    Results

    According to the biological processes and the role of each protein in different pathways, selecting the correct one is possible through the information that the network provides. Eye development, detection of the visible light, visual perception, photoreceptor cell differentiation, camera-type eye development, eye morphogenesis, and angiogenesis are the major biological processes in retinal regeneration. Based on the GO analysis, SHH, STAT3, FGFR1, OPN4, ITGAV, RAX, and RPE65 are effective in retinal regeneration via the biological processes. In addition, based on the centrality analysis, four proteins have the greatest influence on retinal regeneration: SHH, IGF1, STAT3, and ASCL1.

    Conclusion

    With the intention of applying the most impressive growth factors in retinal engineering, it seems logical to pay attention to SHH, STAT3, and RPE65. Utilizing these proteins can lead to fabricate high efficiency engineered retina via all aforementioned biological processes.

    Keywords: Effective Growth Factors, In-silico Study, Regenerative Medicine, Retinal Tissue Engineering, SystemsBiology
  • Ogugua Ndubuisi Okonkwo*, Adekunle Olobola Hassan, Toyin Akanbi Pages 68-76
    Purpose

    To present the anatomical and functional outcomes of autologous surgical transplantation of a free neurosensory retinal graft in three cases of recurrent and chronic full thickness macular hole (MH).

    Method

    A retrospective case series, reporting the profile, preoperative presentation, surgical technique, and postoperative outcome of three consecutive eyes of three patients who had autologous retina transplantation (ART) surgery for recurrent and chronic MHs, and had a minimum of six months follow-up. The technique involved excision of a free neurosensory graft after laser demarcation of the harvest site. The graft was slid under perfluorocarbon liquid (PFCL) into the MH. A five-day tamponade with PFCL was used to secure the graft within the MH and then exchanged with air.

    Results

    The patients were one female and two males aged 60, 44, and 67 years, respectively. All eyes had successful surgery. Postoperative vision improved from 6/36 to 6/18 in patient 1 and remained same as preoperative vision in the other two eyes. No eye lost vision postoperatively. The main complication of surgery was occurrence of retinal and vitreous hemorrhage in one eye (this did not appear to jeopardize the outcome) and retraction of graft tissue in two eyes.

    Conclusion

    ART appears to be a safe and effective treatment for difficult MHs. Our results are comparable to previous studies. Short-term use of PFCL can be useful to secure the graft within the MH. Methods of improving visual function should be the focus of further research in this promising area.

    Keywords: Autologous Transplant, Macular Hole, Neurosensory Retina, Vitrectomy
  • Roshanak Ali-Akbar Navahi, Samira ChaibakhshSayyed Amirpooya Alemzadeh, Kaveh Abri Aghdam* Pages 77-83
    Purpose

    To determine the appropriate number of histopathological cross-sections that are required for a conclusive diagnosis of giant cell arteritis (GCA).

    Methods

    In this cross-sectional study, the number of sections per slide for paraffin-embedded blocks for 100 randomly selected cases where GCA was suspected and those for negative temporal artery biopsies (TABs) were compared with the number of cross-sections per specimen for eight positive-TABs. All aforementioned examinations were conducted at our center from 2012 to 2016. Then, negative-TABs were retrieved and re-evaluated using light microscopy considering the histopathological findings of GCA.

    Results

    Ninety-five paraffin blocks were retrieved. The original mean biopsy length was 15.39 ± 7.56 mm. Comparison of the mean number of cross-sections per specimen for both the positiveand negative-TABs (9.25 ± 3.37 and 9.53 ± 2.46) showed that 9.87 ± 2.77 [95% confidence intervals (CI)] cross-sections per specimen were sufficient for a precise GCA diagnosis. There was no statistically significant difference in the mean biopsy length (P = 0.142) among the eight positive-TABs. Similarly, no significant difference was observed in the number of cross-sections per specimen (P = 0.990) for positive-TABs compared to those for the negative-TABs. After the retrieval of negative-TABs, the mean number of total pre- and post-retrieval cross-sections per specimen was 17.66 ± 4.43. Among all retrieved specimens, only one case (0.01%) showed the histopathological features of healed arteritis.

    Conclusion

    Positive-TABs did not reveal more histological cross-sections than the negative ones and increasing the number of cross-sections did not enhance the accuracy of TAB.

    Keywords: Giant Cell Arteritis, Histopathology Cross-sections, Temporal Artery Biopsy
  • Kashif M Iqbal, Madeline W Hay, Parisa Emami-Naeini* Pages 84-92

    Drug-induced uveitis is an uncommon but important cause of ocular inflammation. Uveitis can be seen in association with various systemic, topical, and intraocular medications. In this article, we review common medications associated with uveitis. Most cases of drug-induced uveitis resolve with termination of the suspected medication with or without administration of topical or systemic steroids. It is important for clinicians to readily identify medications that may cause uveitis in order to provide rapid treatment, avoid consequences of longstanding inflammation, and prevent costly and excessive laboratory testing.

    Keywords: Uveitis, Medication, Medication-induced Uveitis
  • Masood Bagheri*, Mohammad-Hosein Ahoor, Ahad Jafari, Hesam Sadat Hashemi, Mehdi Mohammadkhani Pages 93-102
    Purpose

    Uveitis is the third leading cause of blindness worldwide. This study aimed to summarize the pattern of uveitis in Iran through a systematic review.

    Methods

    This review was conducted according to the guidelines for systematic reviews in the following four steps: literature search, study selection and assessment, inclusion and exclusion criteria, and statistical analysis.

    Results

    One hundred and fifteen articles were identified by an encyclopedic literature search, and three independent investigators examined them according to the defined inclusion and exclusion criteria. Eventually, 109 manuscripts were retrieved and six crosssectional studies covering 3,567 patients were included and reviewed. According to the results, the mean age of patients was 40 years, and sex was not a statistically significant predisposing factor. The most common anatomical pattern of involvement was anterior uveitis, and the prevalence of the other three types of uveitis, including middle, posterior, and pan-uveitis, were almost equal. Overall, the most common etiologies of uveitis in the Iranian population were idiopathic uveitis, toxoplasmosis, Behcet’s syndrome, and Fuchs heterochromic iridocyclitis.

    Conclusion

    This study depicted the pattern of uveitis in the Iranian society; this can help physicians in the diagnostic approach, management, and treatment of patients.

    Keywords: Epidemiology, Iran, Systematic Review, Uveitis
  • Naser Nasiri, Hamid Sharifi*, Azam Bazrafshan, Atefeh Noori, Mohammad Karamouzian, Ali Sharifi Pages 103-112

    Several studies have reported the characteristics of Coronavirus disease 2019 (COVID-19), yet there is a gap in our understanding of the ocular manifestations of COVID-19. In this systematic review and meta-analysis, we investigated the prevalence of ocular manifestations in COVID-19 patients. We searched Pubmed, Embase, Scopus, Web of Science, and medRxiv from December 1, 2019 to August 11, 2020. Two independent reviewers screened the articles, abstracted the data, and assessed the quality of included studies in duplicate. Thirty-eight studies were eligible after screening of 895 unique articles, with a total of 8,219 COVID-19 patients (55.3% female; n = 3,486 out of 6,308 patients). Using data extracted from cross-sectional studies, we performed randomeffects meta-analyses to estimate the pooled prevalence of ocular symptoms along with 95% confidence interval (CI). The prevalence of ocular manifestations was estimated to be 11.03% (95% CI: 5.71–17.72). In the studies that reported the details of observed ocular symptoms, the most common ocular manifestations were dry eye or foreign body sensation (n = 138, 16%), redness (n = 114, 13.3%), tearing (n = 111, 12.8%), itching (n = 109, 12.6%), eye pain (n = 83, 9.6%) and discharge (n = 76, 8.8%). Moreover, conjunctivitis had the highest rate among reported ocular diseases in COVID-19 patients (79 out of 89, 88.8%). The results suggest that approximately one out of ten COVID-19 patients show at least one ocular symptom. Attention to ocular manifestations, especially conjunctivitis, can increase the sensitivity of COVID-19 detection among patients.

    Keywords: Conjunctivitis, COVID-19, Meta-analysis, Ocular Manifestations, Systematic Review
  • Vishwani Persaud-Sharma*, Mary A. Hooshmand Pages 113-121

    Medical attention to vision impairment and associated eye care complications are a vital component of daily living and overall well-being. In the United States today, the physician to patient deficit places great strain on the availability of medical attention tenable to patients nationwide; in terms of specialty medicine, this deficit is even more widespread. The field of ophthalmology faced the same physician to patient deficit in 2020, a grim reality that has left many states void of ophthalmic care, rending millions of aging individuals without domestic eye care. The implementation of trained, ophthalmic nurse practitioners (NPs) can fill the needs of this deficit; however, efficient, accredited, and board-approved American ophthalmic fellowships and residencies that secure proper ophthalmic NP transitions from academia to clinical practice are nonexistent. Though scant, evidence-based literature presents sound findings that support the efficacy and benefit for superior patient outcomes with care provided by ophthalmictrained NPs, offering a viable, long-term solution to the need for ophthalmic medical providers across all states without mitigating patient care, emphasizing the great need for the implementation of ophthalmic NP residencies and fellowships to ensure the continuity of impeccable ophthalmic care for all populations.

    Keywords: Fellowships, Nurse Practitioner, Ophthalmology, Post-graduate Training, Residency, United States
  • Stephanie Wey*, Jason Flamendorf, Sapna Sinha, Daniel Lee Pages 122-126
    Purpose

    We report a case of bilateral acute iris transillumination (BAIT) in a young woman associated with ocular hypertension which eventually progressed to glaucoma that was treated with gonioscopy-assisted transluminal trabeculectomy (GATT).

    Case Report

    A 37-year-old otherwise healthy female presented with intermittently red and inflamed eyes and blurred vision. She was treated with oral moxifloxacin months prior to presentation. Iris transillumination defects, a pigmented anterior chamber reaction, the absence of keratic precipitates, and a history of upper respiratory infection treated with an oral fluoroquinolone prompted the diagnosis of BAIT. Intraocular pressure (IOP) remained uncontrolled on multiple glaucoma medications. Following the development of new visual field defects, indicating progression to glaucoma, GATT with cataract extraction was performed.

    Conclusion

    Although surgical intervention is rare with BAIT, our case demonstrates that GATT may be used effectively in those patients needing better IOP control before considering incisional glaucoma surgery.

    Keywords: Bilateral Acute Iris Transillumination, Fluoroquinolone, Glaucoma, Ocular Hypertension, Gonioscopy-assisted Transluminal Trabeculotomy
  • Renato Menezes Palácios*, Kim Vieira Kayat, Michel Eid Farah, François Devin Pages 127-130
    Purpose

    To describe the surgical approach with a screen-based heads-up, threedimensional (3-D) digital viewing with intraoperative optical coherence tomography (IOCT) for the successful repair of a myopic macular schisis (MMS) case.

    Case Report

    A 62-year-old woman with vision loss in the left eye was scheduled for pars plana vitrectomy (PPV) and MMS repair. Surgery was performed using the NGENUITY® system for surgical viewing, and foveal-sparing internal limiting membrane (fs-ILM) peeling was performed without gas tamponade, after confirming the absence of iatrogenic macular hole with I-OCT. There were no intraoperative or postoperative complications. Visual acuity improved to 20/40 and the subfoveal macular thickness improved from 706 µm (preoperative) to 221 µm after seven months of follow-up.

    Conclusion

    Heads-up digitally assisted viewing technology with I-OCT may be useful or preferred for patients requiring vitreoretinal surgery in the setting of MMS.

    Keywords: Heads-up surgery, 3-D, Intraoperative Optical Coherence Tomography, MyopicMacular Schisis, Foveal-sparing Internal Limiting Membrane Peeling
  • Kais BenAbderrahim* Pages 131-134
    Purpose

    To report a case of nodular anterior scleritis due to poststreptococcal syndrome using optical coherence tomography imaging. Case Report: A 41-year-old woman with a history of acute rheumatic fever presented with a nodular anterior scleritis. Common causes were excluded. Optical coherence tomography of sclera showed enlarged vessels, inflammatory infiltrates, separated fibers, and a serous detachment. Laboratory investigations showed an elevated erythrocyte sedimentation rate, raised anti-streptolysin O titer, and the presence of group A streptococcus in the throat. The scleritis rapidly improved with penicillin treatment.

    Conclusions

    Poststreptococcal syndrome should be considered in the etiology of nonnecrotizing anterior scleritis

    Keywords: Scleritis, Optical Coherence Tomography, Poststreptococcal Syndrome
  • Michael Tsatsos, Ioannis Athanasiadis*, Corrado Gizzi, Balal Shafi, Marilita Moschos, Anant Sharma Pages 135-136
  • Ahmad Mirshahi, Narges Hassanpoor*, Hassan Khojasteh, Mohammad Reza Baradaran, Hooshang Faghihi, Alireza Lashay Pages 137-139
  • Sefik Can Ipek, Sadettin Uslu, Gercek Can, Ozlem Ozbagcivan, Pinar Cakar Ozdal, Ali Osman Saatci* Pages 140-144
  • Siamak Moradian*, Marzieh Ebrahimi, Azade Kanaani, Amir Faramarzi, Sare Saf Page 147