Pretreatment with frequent topical betamethasone in Ahmed glaucoma valve implantation.

OBJECTIVE: To evaluate the efficacy of pretreatment with topical betamethasone in Ahmed glaucoma valve (AGV) implantation. DESIGN: Randomized clinical trial. PARTICIPANTS: Sixty-two eyes from 62 patients undergoing AGV. METHODS: We randomly assigned patients undergoing AGV to 2 arms of the study. The case group received AGV implantation with preoperative betamethasone eye drops, and the control group did not receive preoperative betamethasone. Follow-up examinations were performed on postoperative day 1, at least weekly for 4 weeks, and then every 1 to 3 months. Our main outcome measure was the rate of success, defined as intraocular pressure (IOP) <15 mm Hg and IOP ≤18 mm Hg. RESULTS: We analyzed 62 eyes divided to case (n = 33) and control (n = 29) groups. The success rate was significantly higher in the intervention group than in the control group at 12 months postoperatively when considering either IOP < 15 or IOP < 18 mm Hg as success (p < 0.001) and also at 6 months when considering IOP < 18 mm Hg as success (p < 0.041). The reduction in the number of antiglaucoma medications used postoperatively was significantly higher in the betamethasone group at follow-up at 1 and 3 months and 1 year. CONCLUSION: Pretreatment with topical betamethasone in AGV implantations increases the success rate and reduces the need for medications.

Effect of mitomycin-C on corneal endothelial cell parameters after refractive surface ablation procedures.

Background: The effect of mitomycin-C (MMC) on the reduction of endothelial cell count in the cornea remains controversial. We aimed to evaluate the effect of MMC on corneal endothelial cell parameters after refractive surface ablation procedures, including photorefractive keratectomy (PRK) and laser epithelial keratomileusis (LASEK). Methods: In this interventional, comparative, follow-up study, 342 eyes of 171 patients were followed up for 6 months. Patients undergoing PRK or LASEK were included and were divided into two groups: group one (188 eyes of 94 patients) with an ablation depth of ≥ 65 µm and who received intraoperative 0.02% MMC for 30 s, and group two (154 eyes of 77 patients) with an ablation depth of < 65 µm and who received balanced salt solution for 30 s. Changes in endothelial cell density (ECD), central corneal thickness (CCT), coefficient of variation (CV), and hexagonality values were compared between the groups at 3 and 6 months after surgery. Results: The mean (standard deviaiton [SD]) age of the patients was 28.11 (6.56) years. The mean (SD) ECD did not change significantly in either group between the baseline and at 3 and 6 months postoperatively. The baseline mean ECD was significantly higher in group one than that in group two (P < 0.001) and remained so at 3 (P = 0.002) and 6 months (P = 0.022) postoperatively. The baseline hexagonality value was lower in group one (P = 0.173), with a gradual decrease during the postoperative follow-up as compared with that in group two (P = 0.016 and 0.001 at 3 and 6 months postoperatively, respectively). Group one had a significantly lower CCT at 3 and 6 months postoperatively (both P < 0.001) and a higher mean CV (3 months: P = 0.028; 6 months: P = 0.328). Conclusions: A single intraoperative application of MMC for 30 s as prophylaxis for corneal haze development during refractive surface ablation procedures had no significant effect on ECD up to 6 months postoperatively. Future studies with a contralateral-eye design (to neutralize factors specific to the individual patient), a larger sample size, and longer follow-up are necessary to confirm or disprove our observations.

Cost-effectiveness of neuroimaging technologies in management of psychiatric and insomnia disorders: A meta-analysis and prospective cost analysis.

BACKGROUND: The optimal diagnostic strategy for patients with psychiatric and insomnia disorders has not been established yet. PURPOSE: The purpose of this study was to perform cost-effectiveness analysis of six neuroimaging technologies in diagnosis of patients with psychiatric and insomnia disorders. METHODS: An economic evaluation study was conducted in three parts, including a systematic review for determining diagnostic accuracy, a descriptive cross-sectional study with Activity-Based Costing (ABC) technique for tracing resource consumption, and a cost-effectiveness analysis using a short-term decision-analytic model. RESULTS: In the first phase, 93 diagnostic accuracy studies were included in the systematic review. The accumulated results (meta-analysis) showed that the highest diagnostic accuracy for psychiatric and insomnia disorders was attributed to PET (sensitivity of 90% and specificity of 80%) and MRI (sensitivity of 76% and specificity of 78%) respectively. In the second phase of the study, we calculated the cost of each technology. The results showed that MRI has the lowest cost. Based on the results in the model of cost-effectiveness sMRI ($ 50.08 per accurate diagnosis) and MRI ($ 58.54 per accurate diagnosis) were more cost-effective neuroimaging technologies. CONCLUSION: In psychiatric disorders, no single strategy was characterized by both low cost and high accuracy. However, MRI and PET scan had lower cost and higher accuracy for psychiatric disorders, respectively. MRI was the least costly with the highest diagnostic accuracy in insomnia disorders. Based on our model, sMRI in psychiatric disorders and MRI in insomnia disorders were the most cost-effective technologies.

Organoids and organ chips in ophthalmology.

Recent advances have driven the development of stem cell-derived, self-organizing, three-dimensional miniature organs, termed organoids, which mimic different eye tissues including the retina, cornea, and lens. Organoids and engineered microfluidic organ-on-chips (organ chips) are transformative technologies that show promise in simulating the architectural and functional complexity of native organs. Accordingly, they enable exploration of facets of human disease and development not accurately recapitulated by animal models. Together, these technologies will increase our understanding of the basic physiology of different eye structures, enable us to interrogate unknown aspects of ophthalmic disease pathogenesis, and serve as clinically-relevant surrogates for the evaluation of ocular therapeutics. Both the burden and prevalence of monogenic and multifactorial ophthalmic diseases, which can cause visual impairment or blindness, in the human population warrants a paradigm shift towards organoids and organ chips that can provide sensitive, quantitative, and scalable phenotypic assays. In this article, we review the current situation of organoids and organ chips in ophthalmology and discuss how they can be leveraged for translational applications.

Development of poly (mannitol sebacate)/poly (lactic acid) nanofibrous scaffolds with potential applications in tissue engineering.

Developing a biomimetic substrate with intrinsic potential for cell attachment and growth has always been a tissue engineering challenge. In the present research, we successfully fabricated PMS:PLA nanofibrous scaffolds for the first time using electrospinning process by adjusting blending ratios, feed rates and polymer concentrations. A desirable composition was found when homogenous nanofibers with an average fiber diameter of 235 ±â€¯38 nm were achieved at 10% w/v for PMS:PLA 60:40. The scaffolds were then characterized for their microstructure, mechanical strength and elasticity, degradation rate, porosity, wettability and cell/tissue compatibility. Mechanical analysis and degradation behavior of PMS:PLA nanofibrous scaffolds revealed appropriate elasticity, stiffness and strength, as well as degradation rate appropriate for soft tissues. Nitrogen adsorption-desorption analysis discovered that mesoporous nanofibers with enhanced specific surface area were fabricated. Further in vitro and in vivo biocompatibility evaluations revealed enhanced cytocompatibility, proliferation and tissue responses of PMS:PLA nanofibrous scaffolds with desirable cell-scaffold interactions. Moreover, PMS:PLA nanofibrous scaffolds exhibited negligible inflammatory responses with significantly thinner fibrotic capsule formation and minor infiltration of inflammatory cells compared to PLA nanofibers. These findings suggest that PMS/PLA nanofibrous scaffolds could be introduced as potential candidates with improved properties for soft tissue engineering applications.

Dry Eye Disease: Emerging Approaches to Disease Analysis and Therapy.

Dry eye disease (DED) is among the most common ocular disorders affecting tens of millions of individuals worldwide; however, the condition remains incompletely understood and treated. Valuable insights have emerged from multidisciplinary approaches, including immunometabolic analyses, microbiome analyses, and bioengineering. Furthermore, we have seen new developments in clinical assessment approaches and treatment strategies in the recent past. Here, we review the emerging frontiers in the pathobiology and clinical management of DED.

Single-step transepithelial photorefractive keratectomy in myopia and astigmatism: 18-month follow-up.

PURPOSE: To evaluate the long-term quantitative and qualitative optical outcomes of 1-step transepithelial photorefractive keratectomy (PRK) to correct myopia and astigmatism. SETTING: Bina Eye Hospital, Tehran, Iran. DESIGN: Prospective interventional case series. METHODS: Eyes with myopia with or without astigmatism were evaluated. One-step transepithelial PRK was performed with an aberration-free aspheric optimized profile and the Amaris 500 laser. Eighteen-month follow-up results for refraction, visual acuities, vector analysis, higher-order aberrations, contrast sensitivity, postoperative pain, and haze grade were assessed. RESULTS: The study enrolled 146 eyes (74 patients). At the end of follow-up, 93.84% of eyes had an uncorrected distance visual acuity of 20/20 or better and 97.94% of eyes were within ±0.5 diopter of the targeted spherical refraction. On vector analysis, the mean correction index value was close to 1 and the mean index of success and magnitude of error values were close to 0. The achieved correction vector was on an axis counterclockwise to the axis of the intended correction. Photopic and mesopic contrast sensitivities and ocular and corneal spherical, cylindrical, and corneal coma aberrations significantly improved (all P < .001). A slight amount of trefoil aberration was induced (P < .001, ocular aberration; P < .01, corneal aberration). No eye lost more than 1 line of corrected distance visual acuity. No eye had a haze grade of 2+ degrees or higher throughout the follow-up. CONCLUSIONS: Eighteen-month results indicate the efficacy and safety of transepithelial PRK to correct myopia and astigmatism. It improved refraction and quality of vision. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Factors Associated with Adherence to Colorectal Cancer Screening among Moderate Risk Individuals in Iran.

BACKGROUND: Colorectal cancer is one of the most common neoplasms in Iran. Secondary prevention (colorectal cancer screening) is important and a most valuable method of early diagnosis of this cancer. The objectives of this study were to determine the factors associated with colorectal cancer screening adherence among Iranians 50 years and older using the Health Belief Model. MATERIALS AND METHODS: This cross-sectional study was conducted from June 2012 to May 2013. A convenience sample of 200 individuals aged 50 and older was recruited from the population at outpatient clinics in teaching hospitals. Data gathering tools were the Champions health belief model scale (CHBMS) with coverage of socio-demographic background and CRC screening information. Multiple logistic regression was performed to identify factors associated with colorectal cancer screening adherence. RESULTS: The mean age of participants was 62.5± 10.8 and 75.5% were women. A high percentage of the participants had not heard or read about colorectal cancer (86.5%) and CRC screening (93.5%). Perceived susceptibility to colorectal cancer had the lowest percentage of all of the subscales. Participants who perceived more susceptibility (OR =2.99; CI 95%: 1.23-5.45) and reported higher knowledge (OR =1.29; CI 95%: 1.86-3.40) and those who reported fewer barriers (OR =.37; CI 95%:.21- .89), were more likely to have carried out colorectal cancer screening. CONCLUSIONS: Our findings indicated that CRC knowledge, perceived susceptibility and barriers were significant predictors of colorectal cancer screening adherence. Strategies to increase knowledge and overcome barriers in risk individuals appear necessary. Education programs should be promoted to overcome knowledge deficiency and negative perceptions in elderly Iranians.

On-line pachymetry outcome of ablation in aberration free mode TransPRK.

PURPOSE: There are many independent factors that influence the outcome of refractive surgeries, consisting of patient characteristics and environmental factors. We studied the accuracy of central ablation depth compared to online pachymetry results. METHODS: A total of 153 eyes that underwent TransPRK at Bina Eye Hospital, Tehran, Iran, were evaluated from November 2010 to January 2012 in a retrospective cross-sectional study. The relevant data were registered and bivariate correlations and linear regression association were investigated statistically. RESULTS: The mean age was 29 ± 5 years. Distribution of refractive errors was as follows: compound myopic astigmatism 123 (80.4%), simple myopia 24 (15.7%), and mixed astigmatism 6 (3.9%). Mean ambient temperature and humidity levels intraoperatively were 23.49 ± 1.16°C and 28.91 ± 6.16%, respectively. There was a significant difference (p<0.001) between the preassumed central ablation depth (131.68 ± 32.72 µm) and the net level of ablation depth (measured by online pachymetry, 168.04 ± 41.47 µm). Temperature and humidity levels were not in any statistically significant correlation with the net amount of difference found. The backward linear regression was done to reveal the association between ablation depth and several variables. CONCLUSIONS: This study showed that there is deviation in optical coherence pachymetry online measurements done with SCHWIND AMARIS laser. Ambient temperature and humidity levels intraoperatively do not influence the outcome. However, basic structural characteristics of patients along with change in refractive index and corneal shrinkage because of corneal dehydration are associated with the differences.

The Phase 2 Study of "(TOX) Preoperative Chemotherapy" Response Rate and Side Effects in [Locally Advanced Operable Gastric Adenocarcinoma] Patients With Docetaxel, Oxaliplatin and Capcitabine.

BACKGROUND: Early stage gastric cancer diagnosis has ensued different approaches in resection strategies. In order to increase the proportion of cases which have undergone radical resection or have reduced the recurrence rate, different pre-operative treatments have introduced. Here, we have verified an active preoperative chemotherapeutic regimen in locally advanced gastric cancer patients. METHODS: Forty nine patients who have found eligible to enter this phase 2 trial have treated with oxaliplatin 100 mg/m2 IV, docetaxel 50 mg/m2 IV, plus capecitabine 625 mg/m2 PO (TOX). Clinical staging has been following the first 2 cycles of induction chemotherapy. Patients that have further undergone radical surgery, have evaluated for pathological response rate. RESULTS: Anemia (10.2%), nausea (10.2%) and vomiting (6.1%) were the most frequent grade 3 or 4 adverse effects. Regarding the pathologic staging, 6 patients (12.2%) had complete response (95% CI 3% to 21.4%), 18 of them (36.7%) had partial response (95% CI 23.2% to 50.2%), then 3 patients (6.1%) had stable disease (95% CI 0%-12.8%). Among the patients who had surgery, 22% had pathologic complete response. CONCLUSION: Preoperative chemotherapeutic regimen of TOX seems to be an active and safe neoadjuvant therapy in non metastatic gastric cancer. It should further be considered with concurrent radiotherapy.

Vector analysis of cross cylinder LASIK with the NIDEK EC-5000 excimer laser for high astigmatism.

PURPOSE: To evaluate visual outcomes of LASIK in eyes with high astigmatic refractive errors with low spherical component. METHODS: We prospectively evaluated cross cylinder LASIK in patients with high astigmatic eyes with low spherical component over a 2-year period. All laser surgeries were performed with the NIDEK EC-5000 excimer laser. We used power vectors (M [spherical equivalent] and J(0), and J(45) [cylinder]) to analyze the astigmatic results. Main outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, and complications. RESULTS: Thirty-four eyes of 22 patients were included. Patients were followed for 21.8+/-3.7 months. At the last examination, UCVA of 20/40 or better was observed in 33 (97.1%) eyes. Best spectacle-corrected visual acuity after LASIK improved significantly in comparison to BSCVA before surgery (P<.005). Mean preoperative cylinder was -4.73+/-0.89 diopters (D) (range: -4.00 to -7.00 D), which decreased to -0.29+/-0.47 D (range: 0.00 to -1.50 D) at last follow-up (P<.001). Reduction in the magnitude of power vectors was 92.4% for M, 103.2% for J(0), and 76.4% for J(45). No cases of post-operative astigmatic regression or corneal haze were observed. CONCLUSIONS: Cross cylinder LASIK with the NIDEK EC-5000 excimer laser is a successful procedure for correcting high astigmatism and improving vision.

Long-term evaluation of complications and results of photorefractive keratectomy in myopia: an 8-year follow-up.

PURPOSE: To evaluate 8-year results of photorefractive keratectomy (PRK) for myopia in terms of safety, efficacy, stability, and late complications. METHODS: From 371 myopic eyes of 203 patients who underwent PRK using NIDEK EC-5000 excimer laser with 5.5- to 6-mm ablation zones in Basir Eye Center, Tehran, Iran, during 1997-1998, data of 179 myopic eyes of 98 patients, who participated in annual examinations, were analyzed. Treated eyes were divided into 3 groups according to preoperative refraction: low myopia [-10.00 D). The main outcome measures were safety, efficacy, stability, and postoperative complications. RESULTS: Eight years after PRK, 69.64%, 44.44%, and 45.65% of the low, moderate, and high myopic groups were within +/-0.5 D of emmetropia. Sixteen eyes (4.31% of original cases) underwent retreatment mainly because of regression. Although a small myopic shift occurred up to 8 years after surgery, changes in myopic regression stabilized in all myopic groups within 24 months. Four eyes (2.06%) lost 2 lines of best spectacle-corrected visual acuity (1 eye for corneal haze and other 3 for problems not related to refractive surgery). Corneal haze occurred in 11.34% especially in medium and high myopic groups, but it cleared within 2 years in 68.2% of cases. CONCLUSIONS: Based on our study, PRK seems to be a safe, efficient, and stable surgical procedure, and if patients obtain a good result with the initial treatment, then their results are relatively stable over time.