Combined simultaneous photorefractive keratectomy and collagen cross-linking in keratoconus suspect patients.

PURPOSE: To evaluate the safety and efficacy of combined simultaneous photorefractive keratectomy (PRK) with collagen cross-linking (CXL) in keratoconus suspects (KCS). METHODS: This was a retrospective, non-randomized study of KCS patients who underwent combined simultaneous PRK with CXL. The efficacy, safety, refractive outcomes, and corneal wavefront aberration changes were assessed after the surgery and compared with existing preoperative data. RESULTS: Fifty-six eyes of 28 patients, including 20 females (71.4%), with a mean age of 30.92±4.09 years, were enrolled. The mean follow-up was 19.46±8.48 months (range: 7-35). At the conclusion of the study, mean uncorrected distance visual acuity LogMAR improved from 0.89±0.44 preoperatively to 0.04±0.09 postoperatively (P<0.001). In addition, a statistically significant corneal flattening was observed postoperatively, with a decrease in manifest refraction. A statistically significant increase was found in higher-order aberrations (P<0.001), horizontal coma (P<0.001), and spherical aberration (P<0.001) compared with preoperatively. Postoperatively, 41% exhibited refractive astigmatism of 0.50 diopter (D) or less; 83.8% showed 1.00 D or less. CONCLUSION: The results of our study indicate that combined simultaneous PRK with CXL can be a safe and effective method for treating refractive instability in KCS patients.

Comparison of Indocyanine Green Angiography and Fluorescein Angiography for Imaging of Central Serous Chorioretinopathy Patients as Candidates for Photodynamic Therapy.

PURPOSE: To compare fluorescein angiography (FA) and indocyanine green angiography (ICGA) for imaging of central serous chorioretinopathy (CSC) patients. METHODS: The observational cross-sectional clinical study was conducted on 131 eyes of 131 patients with CSC who were candidates for photodynamic therapy (PDT). An experienced ophthalmologist marked the leakage sites and choroidal hyperpermeability sites that needed PDT. For each eye, simultaneous FA and ICGA imaging with the maximum leakage area was selected for comparison regarding the site and size. RESULTS: The mean±standard deviation age of patients was 44.53±9.03 years. Of 226 leakage points, 177 (78.32%) points were in the same site, and 168 (74.34%) points were in the same size on FA. No statistical difference was found between age (P=0.45), sex (P=0.32), and chronicity (P=0.11) of the disease in comparing the ICGA images to the FA images regarding leakage at the same site. A statistically significant difference was also found regarding size of leakage and chronicity (P<0.001). CONCLUSION: The current results suggested that FA could be considered an alternative ocular imaging technology as a guide for PDT in CSC patients.

Corneal biomechanical properties after soft contact lens wear measured on a dynamic Scheimpflug analyzer: A before and after study.

OBJECTIVES: To evaluate the corneal biomechanics before and after daily use of contact lenses (CLs), measured by Scheimpflug-based devices. METHODS: This prospective clinical study includes participants who were scheduled to use CLs daily for refractive error. The biomechanical parameters were measured by the Corneal Visualization Scheimpflug Technology (Corvis ST) before and one month after using the soft CLs. RESULTS: Twenty-three subjects (46 eyes), including 16 female (76.2%) with a mean age of 28±7.29 years, were enrolled. There was no significant difference among biomechanical factors measured before and after contact lens wear (P>0.05). Using regression analysis of the biomechanical markers, we found a statistically significant association between second applanation length (A2 length) (P=0.001), highest concavity radius (HCR) (P=0.05), deflection amplitude ratio (DA_ratio) (P=0.05) and integrated radius (P<0.001) with age. Regarding spherical equivalent, we found a statistically significant association between central corneal thickness (CCT) (P=0.05), A2 length (P=0.03) and stiffness parameter at first applanation (SPA1) (P=0.02). CONCLUSIONS: We did not find a significant difference in terms of corneal biomechanical parameters between baseline and month 1; but regression analyses showed a statistically significant association between A2 length, HCR, DA_ratio, integrated radius, CCT and SPA1 and certain subject characteristics.

Acute vision loss in systemic lupus erythematosus: bilateral combined retinal artery and vein occlusion as a catastrophic form of clinical flare.

Presentation of a combination of branch retinal artery occlusion (BRAO)/central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) in systemic lupus erythematosus (SLE) is extremely rare. Herein, we have presented the case of a 29-year-old female with SLE, who simultaneously developed bilateral CRVO and BRAO/CRAO in the absence of antiphospholipid syndrome (APS) as a catastrophic form of clinical flare. A combinatorial diagnosis of CRVO and BRAO/CRAO should be considered during clinical flare-up in a patient with SLE who presents with rapidly progressive visual loss.

Photokeratitis induced by ultraviolet radiation in travelers: A major health problem.

Ultraviolet (UV) irradiation is one of the several environmental hazards that may cause inflammatory reactions in ocular tissues, especially the cornea. One of the important factors that affect how much ultraviolet radiation (UVR) humans are exposed to is travel. Hence, traveling is considered to include a more acute UVR effect, and ophthalmologists frequently evaluate and manage the ocular manifestations of UV irradiation, including UV-induced keratitis. The purpose of this paper is to provide an evidence-based analysis of the clinical effect of UVR in ocular tissues. An extensive review of English literature was performed to gather all available articles from the National Library of Medicine PubMed database of the National Institute of Health, the Ovid MEDLINE database, Scopus, and ScienceDirect that had studied the effect of UVR on the eye and its complications, between January 1970 and June 2014. The results show that UVR at 300 nm causes apoptosis in all three layers of the cornea and induces keratitis. Apoptosis in all layers of the cornea occurs 5 h after exposure. The effect of UVR intensity on the eye can be linked to numerous factors, including solar elevation, time of day, season, hemisphere, clouds and haze, atmospheric scattering, atmospheric ozone, latitude, altitude, longitudinal changes, climate, ground reflection, and geographic directions. The most important factor affecting UVR reaching the earth's surface is solar elevation. Currently, people do not have great concern over eye protection. The methods of protection against UVR include avoiding direct sunlight exposure, using UVR-blocking eyewear (sunglasses or contact lenses), and wearing hats. Hence, by identifying UVR intensity factors, eye protection factors, and public education, especially in travelers, methods for safe traveling can be identified.

Looking beyond the cosmetic tattoo lesion near the eyebrow: Screening the lungs.

Cosmetic tattooing has become a risk factor for several adverse reactions related to inks, procedures, and associated clinical conditions. Development of a sarcoid reaction to the inserted tattoo pigment in the skin is not common. We report a 45 year-old patient with history of dyspnea and mild cough since two years who had subsequently developed reddish, scaly lesions in her 15-year old tattoo done near her right eyebrow. Skin biopsy of the tattoo lesion revealed cutaneous sarcoidosis which led to further investigations and a diagnosis of pulmonary sarcoidosis. The present case highlights the fact that cutaneous sarcoidosis can develop in a long-standing tattoo. Also such a patient should be screened for systemic sarcoidosis disease.

Lupus and lupoid misnomer: issues and challenges.

Misnomers are terms for any of medical conditions whose name does not reflect the pathophysiological reality. In the field of dermatology, it is interesting to note that there are some misnomers about lupus. Lupus is Latin for wolf, and it comes from the facial appearance that was thought to resemble the bites of a wolf. Until the 19th century, lupus was most commonly caused by cutaneous tuberculosis (TB), so some of the misnomer related to TB. Other misnomers encountered in lupus have arisen from the lack of understanding of the underlying etiology, pathogenesis and histopathological features, due to imprecise translations.