Topical Medroxyprogesterone Acetate and Corneal Epithelium Healing after Photorefractive Keratectomy: A Randomized, Double-masked Contralateral Eye Study.

Objective: The objective of the study was to evaluate the efficacy and safety of topical 1% medroxyprogesterone in corneal epithelial healing after photorefractive keratectomy (PRK). Methods: In this placebo-controlled double-masked randomized contralateral eye study, 66 eyes of 33 patients with myopia and myopia-astigmatism were assigned into two groups to receive either 1% topical medroxyprogesterone (intervention) or artificial tear (placebo) at the end of PRK surgery. The patients were followed up daily for 5 days until epithelial healing was achieved. The time taken for epithelial healing was the main outcome measure. Findings: The mean age of the subjects was 32.97 ± 7.6 years and 46 individuals were female (69.7%). All baseline refractive characteristics were comparable between the groups. There was no significant difference between the two groups in terms of epithelial defect size on Day 1 (P: 0.67). Both groups exhibited a consistent pattern of decreasing epithelial defect size from Day 1 to Day 5, with the control group having slightly worse initial values. There were no significant differences between the groups in the following days. Both groups showed substantial reductions in the epithelial defect size, but the intervention group showed a more prominent decrease on Day 2. The intervention did not show a significant statistical difference compared to the control group, and both groups ended up with a similar outcome. Conclusion: These findings suggest that the topical 1% medroxyprogesterone does not significantly affect the healing of corneal epithelium after PRK.

Risk Factors of COVID-19 associated mucormycosis in Iranian patients: a multicenter study.

BACKGROUND: To evaluate the demographic, clinical, and prognostic characteristics of patients diagnosed with COVID-19-associated mucormycosis (CAM) in Iranian patients. METHODS: This prospective observational study was conducted in 8 tertiary referral ophthalmology centers in different provinces of Iran during the fifth wave of the COVID-19 pandemic. All patients were subjected to complete history taking and comprehensive ophthalmological examination and underwent standard accepted treatment strategy based on the disease stage. RESULTS: Two hundred seventy-four CAM patients (most were males (150, 54.7%)) with a mean age of 56.8 ± 12.44 years were enrolled. Patients with a history of cigarette smoking (Adjusted Odds Ratio (AOR) = 4.36), Intensive Care Unit admission (ICU) (AOR = 16.26), higher stage of CAM (AOR = 2.72), and receiving endoscopic debridement and transcutaneous retrobulbar amphotericin B (AOR = 3.30) had higher odds of mortality. History of taking systemic corticosteroids during COVID-19 was significantly associated with reduced odds of mortality (AOR = 0.16). Generalized Estimating Equations analysis showed that the visual acuity of deceased patients (LogMAR: 3.71, 95% CI: 3.04-4.38) was worse than that of patients who were discharged from the hospital (LogMAR: 2.42, 95% CI: 2.16-2.68) (P < 0.001). CONCLUSIONS: This study highlights significant risk factors for mortality in patients with CAM, such as cigarette smoking, ICU admission, advanced CAM stages, receiving transcutaneous retrobulbar amphotericin B and worser visual acuity. Conversely, a history of systemic corticosteroid use during COVID-19 was linked to reduced mortality. These findings underscore the critical need for early identification and targeted interventions for high-risk CAM patients to improve clinical outcomes.

Fuchs' uveitis syndrome: a 20-year experience in 466 patients.

Fuchs Uveitis Syndrome (FUS), also known as Fuchs Heterochromic Iridocyclitis, is a chronic form of uveitis characterized by mild inflammation primarily affecting one eye. This study aimed to investigate the clinical and epidemiological features of FUS in an Iranian population. A retrospective analysis was conducted on 466 patients diagnosed with FUS at an ophthalmology center affiliated with Isfahan University of Medical Sciences between 2003 and 2021. The Kimura et al. criteria were used for FUS diagnosis. Demographic data, clinical characteristics, misdiagnosed cases, concurrent diseases, and associated ocular findings were analyzed. The study included 507 eyes of 466 FUS patients, with a mean age of 34.01 ± 11.25 years. Iris atrophy, keratic precipitates, and vitritis were common clinical findings. Heterochromia was an infrequent feature. Initial misdiagnosis occurred in 13 patients, with pars planitis being the most common incorrect diagnosis. Toxoplasmosis and multiple sclerosis were common concurrent diseases. Pediatric FUS cases were noted, possibly attributed to early-onset manifestations. Differences in clinical characteristics were observed when compared to other populations. This study provides insights into the clinical and epidemiological aspects of FUS in an Iranian population. Variations in clinical features, misdiagnosis patterns, and concurrent diseases were noted. Attention to specific clinical parameters can aid in accurate FUS diagnosis. Understanding these differences contributes to a better understanding of FUS presentation and its relationship with other diseases.

Corneal biomechanics in normal and subclinical keratoconus eyes.

BACKGROUND: The diagnosis of keratoconus, as the most prevalent corneal ectatic disorder, at the subclinical stage gained great attention due to the increased acceptance of refractive surgeries. This study aimed to assess the pattern of the corneal biomechanical properties derived from Corneal Visualization Scheimpflug Technology (Corvis ST) and evaluate the diagnostic value of these parameters in distinguishing subclinical keratoconus (SKC) from normal eyes. METHODS: This prospective study was conducted on 73 SKC and 69 normal eyes. Subclinical keratoconus eyes were defined as corneas with no clinical evidence of keratoconus and suspicious topographic and tomographic features. Following a complete ophthalmic examination, topographic and tomographic corneal assessment via Pentacam HR, and corneal biomechanical evaluation utilizing Corvis ST were done. RESULTS: Subclinical keratoconus eyes presented significantly higher Deformation Amplitude (DA) ratio, Tomographic Biomechanical Index (TBI), and Corvis Biomechanical Index (CBI) rates than the control group. Conversely, Ambrósio Relational Thickness to the Horizontal profile (ARTh), and Stiffness Parameter at the first Applanation (SPA1) showed significantly lower rates in SKC eyes. In diagnosing SKC from normal eyes, TBI (AUC: 0.858, Cut-off value: > 0.33, Youden index: 0.55), ARTh (AUC: 0.813, Cut-off value: ≤ 488.1, Youden index: 0.58), and CBI (AUC: 0.804, Cut-off value: > 0.47, Youden index: 0.49) appeared as good indicators. CONCLUSIONS: TBI, CBI, and ARTh parameters could be valuable in distinguishing SKC eyes from normal ones.

Systemic isotretinoin therapy and central macular and choroidal thicknesses in acne vulgaris: is there any association?

PURPOSE: To investigate the effect of oral isotretinoin therapy on central macular thickness (CMT) thickness and choroidal thickness (CT) using optical coherence tomography (OCT). METHODS: CT and CMT thickness of 43 eyes were evaluated at baseline, the third, and sixth month of isotretinoin therapy by spectral-domain OCT. For assessment of CT, OCT measurements were obtained at the fovea with six additional measurements at adjacent locations (at 500-1000 µm temporal to the fovea and 500-1000 µm nasal to the fovea). RESULTS: Forty-three eyes from 43 patients with acne vulgaris, including 33 females (76.7%), who had a mean age of 24.81 ± 6.60 years, completed the study. The mean CMT was 231.49 ± 19.52 at the baseline and significantly decreased to 229.0 ± 19.57 (p = 0.02) and 229.28 ± 18.83 after three and six months, respectively (p < 0.03). The change in the macular thicknesses measured at four quadrants and choroidal thicknesses were not statistically significant during the study (p > 0.05). CONCLUSION: The result of our study demonstrated choroidal thickness change is not significant in patients with acne vulgaris after systemic isotretinoin therapy during six months of follow-up. The decreased CMT amount was 2.2 microns; even if statistically significant, this amount is clinically insignificant.

Diabetic retinopathy and corneal endothelial parameters: an analytical cross-sectional study.

BACKGROUND: To investigate the possible association of different pattern of diabetic retinopathy (DR) on corneal endothelium cells in type 2 diabetes mellitus patients. METHODS: In this descriptive-analytical cross-sectional study, corneal endothelium parameters including endothelial cell density (ECD), average cell size (AVG), coefficient of variation in cell size (CV), and hexagonality (Hex) were evaluated by non-contact specular microscopy. RESULTS: One hundred and thirty-four eyes of 134 diabetic patients including 77 females (57.5%) with a mean age of 61.03 ± 8.08 years were enrolled. The overall corneal parameters in diabetic patients with and without retinopathy were not significantly different (P > 0.05). There is a significant relationship between CV and the duration of the disease with age variable control (B = 0.369, p-value < 0.001). CONCLUSIONS: Corneal endothelial parameters were not associated with DM in patients without and with DR. There is a significant relationship between CV and the duration of the disease with age variable control.

Corneal Cross-Linking in Pellucid Marginal Degeneration: Evaluation after Five Years.

Purpose: To evaluate the long-term outcome of corneal cross-linking (CXL) for pellucid marginal degeneration (PMD). Methods: In a retrospective study, forty eyes of forty patients were enrolled. All subjects had undergone CXL for PMD at least 5 years before the assessments. Visual acuity, refraction, and topography data were compared to their respective values before CXL. Results: The comparison between mean preoperative logMAR uncorrected visual acuity and 5-year postoperative evaluation revealed no significant change (1.20 ± 0.65 and 1.17 ± 0.64, P > 0.05). No statistically significant difference was noted comparing preoperative mean logMAR best-corrected visual acuity (BCVA) and postoperative mean logMAR BCVA (0.24 ± 0.19 and 0.22 ± 0.20, P > 0.05). We did not find any significant difference between pre- and postoperative spherical equivalent and spherical refractive errors (P = 0.419 and P = 0.396, respectively). Regarding the BCVA Snellen lines, 23 eyes had no significant change in pre- and postoperative examinations, 11 eyes had improvement, and 6 subjects showed worsening defined as significant when two or more lines change. The spherical equivalent refractive error improved in 4 subjects, was stable in 25, and worsened in 11 subjects, while a 0.5 diopter or more myopic change was considered significant. Furthermore, regarding steep keratometry values, 25 subjects were stable, 7 had improvements, and 8 worsened. Conclusion: CXL appears to be a safe and effective procedure to halt the progression of PMD.

Multivariable analysis of clinical and laboratory data manifestations predicting severity and mortality risk in patients with Coronavirus disease 2019 in the mountainous west of Iran: a retrospective single-center study.

Background: Few reports have addressed the clinical and laboratory features of patients with coronavirus disease-2019 (COVID-19) in mountainous areas, especially in Iran. Objectives: To report the clinical and laboratory data and manifestations predicting mortality of patients with COVID-19 in the west of Iran. Methods: We conducted a retrospective cohort study of 286 patients hospitalized with COVID-19 between 25 February 2020 and 12 May 2020 to describe their clinical symptoms and laboratory test findings when they were admitted at the Hajar Hospital affiliated with the Shahrekord University of Medical Sciences, and a multivariable analysis of factors that predict their disease severity and mortality. Results: After hospital admission, 18 patients died and 268 were discharged. Older age [odds ratio (OR) = 1.02, 95% confidence interval (CI) = 1.01-1.04, P = 0.001], presence of underlying diseases (OR = 1.86, 95% CI = 1.01-3.45, P = 0.04), elevated hematocrit (OR = 1.08, 95% CI = 1.03-1.13, P = 0.002), and increase in red blood cell distribution width (RDW) coefficient of variation (OR = 1.18, 95% CI = 1.02-1.36, P = 0.02) were significantly associated with disease severity. Older age (OR = 1.00, 95% CI = 1.00-1.07, P = 0.03), hypocalcemia (OR = 0.20, 95% CI = 0.09-0.58, P = 0.002), hypophosphatemia (OR = 0.50, 95% CI = 0.26-1.02, P = 0.04), and increase in platelet-larger cell ratio (P-LCR; OR = 1.10, 95% CI = 1.00-1.15, P = 0.04) were significantly associated with mortality. The areas under the receiver operating characteristic curves were as follows: calcium 0.759; lactate dehydrogenase (LDH) 0.731; phosphorus 0.725; bilirubin 0.689; C-reactive protein 0.679; and RDW - standard deviation (RDW-SD) 0.624. Conclusions: Those who did not survive tended to be elderly and had a greater incidence of comorbidities. Elevated LDH, decreased levels of calcium and phosphorus, and anemia at diagnosis were associated with greater risk of death for these Iranian patients hospitalized with COVID-19. Regular assessment of these markers would help to manage patients with COVID-19.

Evaluation of optical coherence tomography angiography parameters in patients treated with Hydroxychloroquine.

BACKGROUND: One of the major side effects of Hydroxychloroquine (HCQ) is retinopathy. The aim of this study was to evaluate the Optical coherence tomography angiography (OCTA) parameters in a group of patients who have Hydroxychloroquine-induced retinopathy based on Multifocal electroretinography (mfERG) with a group who do not have retinopathy. METHOD: This is a Cross-Sectional Study. In this study, patients with Rheumatoid arthritis (RA) or Systemic lupus erythematosus (SLE) who had been taking Hydroxychloroquine for at least 7 years were included. MfERG and OCTA imaging were performed for all patients. Patients were divided into Normal mfERG and Abnormal mfERG groups based on mfERG results. OCTA parameters were studied in these two groups. RESULT: Sixty-one patients (61 eyes) were included. Forty-one patients had SLE and 20 patients had RA. Forty patients (66.7%) had Abnormal mfERG. The mean vascular density (VD) in Superficial capillary plexus (SCP) layer was not significantly different between Normal mfERG and Abnormal mfERG groups (P-Value> 0.05). Mean VD in SCP layer was not significantly different between Normal mfERG and Abnormal mfERG groups (P-Value> 0.05). In RA subgroup, mean VD in SCP layer in PeriFovea region in Abnormal mfERG group was significantly lower than normal group (P-Value < 0.05). Mean VD in deep capillary plexus (DCP) layer in Whole Image, Superior Hemi, Inferior Hemi, PeriFovea area in Abnormal mfERG group was significantly lower than normal group (P-Value < 0.05). This discrepancy was also observed in the RA subgroup but not in the SLE subgroup. The mean of none of the parameters of foveal avascular zone (FAZ) (mm2), Flow Area of Outer Retina (mm2) and Flow Area of Choriocapillaris (mm2) were not statistically significant between the groups Abnormal mfERG and Normal mfERG. (p-value> 0.05). CONCLUSION: VD in the DCP layer decreased in abnormal mfERG patients compared to patients with normal mfERG. But it seems that VD in SCP layer, FAZ Area and Flow Area are similar in both groups. OCTA may be used as a non-invasive tool in the diagnosis of early stages of HCQ-induced retinopathy, especially in RA patients, but further studies are needed.

Assessing the measurement invariance of the 10-item Centre for Epidemiological Studies Depression Scale and Beck Anxiety Inventory questionnaires across people living with HIV/AIDS and healthy people.

BACKGROUND: Recently, extensive research has been reported the higher rate of depression and anxiety among people living with HIV/AIDS (PLWHAs) as compared to the general population. However, no single study has been carried out to investigate whether this disparity is a real difference or it happens due to lack of measurement invariance. This study aims to assess the measurement invariance of the Beck Anxiety Inventory (BAI) and 10-item Centre for Epidemiological Studies Depression Scale (CESD-10) questionnaires across PLWHAs and healthy individuals. METHODS: One hundred and fifty PLWHAs and 500 healthy individuals filled out the Persian version of the BAI and CESD-10 questionnaires. Multi-group multiple-indicators multiple-causes model (MG-MIMIC) was used to assess measurement invariance across PLWHAs and healthy people. RESULTS: Our findings revealed that PLWHAs and healthy individuals perceived the meaning of all the items in the BAI and CESD-10 questionnaires similarly. In addition, although depression scores were significantly higher in PLWHAs as opposed to the healthy individuals, no significant difference was observed in anxiety scores of these two groups. CONCLUSIONS: The current study suggests that the BAI and CESD-10 are invariant measures across PLWHAs and healthy people which can be used for meaningful cross-group comparison. Therefore, in comparison to healthy individuals, higher depression score of PLWHAs is a real difference. It is highly recommended that health professionals develop therapeutic interventions and psychological supports to promote the mental health of PLWHAs which alleviate their depressive symptoms.

Comparative evaluation of Gracilaria algae 3% cream vs Clobetasol 0.05% cream in treatment of plaque type psoriasis: A randomized, split-body, triple-blinded clinical trial.

Gracilaria algae is red macro algae which has demonstrated considerable anti-inflammatory effects. Our objective was to compare the efficacy of Gracilaria algae topical cream 3% vs Clobetasol cream 0.05% in treatment of plaque-type psoriasis. Thirty adult patients with baseline modified Psoriasis Area and Severity Index (PASI) score ≤12 were randomized to receive either Clobetasol or Gracilaria algae cream on right or left-sided symmetric plaques once daily for 8 weeks and follow-up of 4 weeks. Modified PASI score, patient's satisfaction using VAS and global physician assessment score were assessed to evaluate clinical response. Thirty patients with 94 symmetrical psoriasis plaques were enrolled in this trial. The mean baseline modified PASI score of both sides was similar; however, at the end of trial, modified PASI score was reduced more on the sides treated with Gracilaria algae cream (0.80 ± 0.19% vs 0.63 ± 0.25%, P < .05). No significant difference was found regarding mean physician global assessment score between the two groups (P > .05). Patients' satisfaction was significantly higher in favor of algae cream only at week 8 of the intervention (P < .05). Gracilaria algae cream can be an effective and safe alternative of Clobetasol in the treatment of plaque type psoriasis.

Clinical outcomes of transverse myelitis with myelin oligodendrocyte glycoprotein antibody versus negative cases among adults in Isfahan, Iran: A comparative study.

Background: The aim of this study was to evaluate the status of anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in patients with transverse myelitis (TM) and compare the clinical and imaging characteristics of MOG immunoglobulin G (IgG)-positive with negative cases. Methods: This cohort study enrolled 71 patients diagnosed with new-onset of TM who were being followed at a referral university clinic in Isfahan, Iran, from November 2016 to January 2019. Magnetic resonance imaging (MRI) images and blood samples for anti-MOG, anti-aquaporin 4 (anti-AQP4) (using the cell-based technique), and vasculitis-related antibodies were collected from patients. Outcomes were assessed by the evolution of the Expanded Disability Status Scale (EDSS) score and brain and spinal cord imaging findings within three months. All patients underwent imaging and clinical assessment during a mean period of one year as a follow-up. We compared the characteristics of clinical and radiological outcomes in MOG-IgG-positive and negative cases. Results: Of the total population studied, there were 26.8% men and 73.2% women, with a mean age of 33 ± 10 years. 12 (16.9%) patients were seropositive for MOG antibody and 17 (89.5%) were positive for anti-AQP4 antibodies. There was no significant association between anti-MOG antibody seropositivity and age, gender distribution, the presence of other autoimmune diseases, and number and interval of relapses. However, the involvement site of the spine at first imaging was significantly different between seronegative and seropositive patients. Conclusion: In patients with MOG antibody disease (MOG-AD) TM, the MRI findings suggest a preferential involvement of the cervical-thoracic section in seropositive cases which may help differentiate from non-MOG demyelination TM.

A novel formulation for radiotherapy-induced oral mucositis: Triamcinolone acetonide mucoadhesive film.

BACKGROUND: The main purpose of this study was to evaluate the effectiveness of triamcinolone acetonide (TA) mucoadhesive films versus placebo as a preventive and therapeutic intervention of oral mucositis (OM) induced by radiotherapy for head-and-neck cancer (HNC) patients. MATERIALS AND METHODS: In this double-blind, randomized case-controlled clinical trial, 60 HNC patients were randomized to receive TA mucoadhesive films (n = 30) or placebo mucoadhesive films (n = 30) taken four times daily. Mucositis severity was assessed during the course of radiation therapy using the World Health Organization scales, and pain scores were assessed using visual analog scale. Repeated measures ANOVA was used for data analysis. RESULTS: Mean ± standard deviation age of the TA group was 58.53 ± 8.89 years and 60% were male, whereas in the placebo group, it was 56.46 ± 9.36 years and 56.7% were male (P > 0.05). The mean value of pain score was significantly reduced in the TA group (5.36 ± 1.29 vs. 2.20 ± 2.02) compared with the placebo group (5.34 ± 0.78 vs. 4.69 ± 0.77) during 4 weeks (P < 0.001); repeated measures ANOVA analysis showed that the mean value of grade mucositis was significantly reduced in the TA group (2.40 ± 0.49 vs. 0.96 ± 0.81) compared with the placebo group (2.36 ± 0.80 vs. 1.86 ± 0.93) during 4 weeks (P < 0.001). CONCLUSION: TA film could be considered as an effective approach for reducing the mucositis grading and pain score in the patients with OM.

Anti-HSV-2 antibody in patients with MS and NMO.

BACKGROUND: Multiple sclerosis (MS) and neuromyelitis optica (NMO) are demyelinating disorders of the central nervous system. There is growing evidence that viruses may play a causal role in these diseases. Human herpes viruses have been of special attention since their DNA have been detected in many of MS patients' samples. Human herpes simplex virus 2 (HSV-2) is a member of this family which has not been investigated thoroughly in MS and NMO. METHODS: We took blood samples from 90 subjects including 30 RRMS patients, 30 NMO patients and 30 healthy controls. After serum isolation, all serum samples were frozen at -70 °C to be used for enzyme linked immunosorbent assay (ELISA) for detection of specific antibodies against HSV-2. Presence or absence of antibodies against HSV-2 was determined based on the cut-off calibrator and index values were then determined. A value of <0.9: negative, between 0.9 and 1.1: equivocal and <1.1: positive. RESULTS: Mean age of all subjects was 33.36 and female to male ratio was 4.3/1. None of the subjects were seropositive for anti-HSV-2 antibody. Analysis indicated no significant differences (P-value >0.05) among antibody levels between MS (0.19 ±â€¯0.08), NMO (0.22 ±â€¯0.16) and control (0.21 ±â€¯0.09) groups. There were also no correlations between mean antibody index or O.D. and subjects' sex, family history, blood group, smoking history, age and presence of visual-motor-sensory or other forms of disability in any of the three MS, NMO and control groups (P-value >0.05). CONCLUSION: We found no associations between patients' diagnosis of MS or NMO and mean anti-HSV-2 antibody index and O.D. levels.