Vision-related quality of life in patients with retinal vein occlusion.

PURPOSE: This study aims to assess the vision-related quality of life in patients with retinal vein occlusion (RVO) among those referred to Labbafinejad Medical Center and Imam Hossein Hospital between 2019 and 2021. METHODS: This comparative study included 37 eligible patients diagnosed with various types of RVO, with an average age of 61 ± 9. To ensure data validity, we included 74 age- and sex-matched healthy individuals. Only cases with a definitive diagnosis of RVO, confirmed by two retina specialists (ND and RN), were included. We assessed the vision-related quality of life of our participants using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). All participants underwent interviews. RESULTS: In our study, we examined the vision-related quality of life in different subgroups of RVO patients. Overall, RVO patients had a significantly lower total VRQoL score compared to healthy individuals (P < 0.001), except in the subscale analysis of specific factors such as ocular pain, color vision, and driving, where no statistically significant difference was observed. A statistically significant difference was found in the comparison of subgroups, indicating lower VRQoL in central retinal vein occlusion (CRVO) patients (P = 0.010). Furthermore, a significant correlation was observed between lower VRQoL and decreased vision (P = 0.009) as well as longer disease duration (P = 0.011). CONCLUSION: Retinal vein occlusion can significantly reduce vision-related quality of life, particularly in more severe cases.

Fundus torsion following inferior oblique muscle weakening.

PURPOSE: To determine the postoperative fundus torsion following surgical inferior oblique (IO) weakening in patients with inferior oblique overaction (IOOA). METHODS: In this interventional case series, 37 patients with IOOA ≥ +1 and reliable preoperative fundus photographs were included. IO weakening was accomplished through myectomy or anterior transposition. Fundus photography was repeated at 3 months' follow-up. The primary outcome was change of disk foveal angle (DFA), measured as the angle between the line connecting the center of the fovea and optic disk and horizontal. Success or normal fundus torsion was defined as a postoperative angle of 0° to 8° of extorsion. Residual extorsion was defined as postoperative extorsion of > 8°. Postoperative intorsion was defined as any amount of induced intorsion. RESULTS: Mean age of patients (56% females) was 6.46 ± 6.79 years. At follow-up at least 3 months after surgery, the mean change of DFA was 7.79 ± 6.24° of reduction of extorsion after IO myectomy (P < 0.001) and 6.05 ± 6.07° after IO anterior transposition (P = 0.005). Normal fundus torsion was achieved in 50% of patients after myectomy and 36.4% of patients after anterior transposition. Residual extorsion was observed in 49% of patients; induced intorsion in 5%. CONCLUSIONS: Using objective measurement of fundus photographs, fundus extorsion was decreased in 94.7% of patients after myectomy or anterior transposition.

The effect of topical ketorolac tromethamine on macular thickening after phacoemulsification in diabetic patients.

BACKGROUND: To determine the effect of ketorolac tromethamine 0.5% in preventing post-phacoemulsification macular thickening. This randomized clinical trial. patients randomized 1:1 to receive either topical ketorolac three times a day or a placebo. METHODS: A total of 101 eyes of 101 diabetic patients who were scheduled for phacoemulsification and had normal macular contour and thickness enrolled consecutively. The topical ketorolac and placebo were prescribed on the day before surgery and continued up to 4 weeks after surgery. Patients with proliferative diabetic retinopathy, a history of intravitreal injection in less than three months, a history of macular photocoagulation in less than 6 months, and any other concomitant ocular pathologies were excluded. Central macular thickness (CMT) and best corrected visual acuity (BCVA) was recorded in the follow-ups of 6, 12, and 24 weeks after the surgery and compared with the controls. RESULTS: 49 eyes in the case group and 52 eyes in the control group were analyzed. Mean BCVA was significantly improved in both groups at all follow-ups (P < 0.001 for all). There was no statistically significant difference regarding the BCVA in different time points except week 12 (P = 0.028) among the study group. In the case and control groups, CMT was increased at all follow-ups (P < 0.05). There was no statistically significant difference when comparing the two groups regarding the mean of CMT at any time point postoperatively (P > 0.05 for all). CONCLUSION: Based on our findings, topical ketorolac tromethamine 0.5% is not effective in the prevention of post-phacoemulsification macular thickening in diabetic patients. TRAIL REGISTRATION: The study protocol was registered into www. CLINICALTRIAL: gov with the RCT registration number NCT03551808. (2018/06/11 ) CLINICAL TRIAL REGISTRATION NUMBER: NCT03551808.

Risk Factors Associated with Keratoconus in an Iranian Population.

Purpose: To determine associated factors for keratoconus (KCN) in the Iranian population. Methods: In this retrospective case-control study, 100 KCN patients and 200 age- and sex-matched individuals, who were either candidates for photorefractive keratectomy or healthy referrals from the Torfeh Eye Hospital, were included as the case and control groups, respectively. KCN patients were all registered at the Iranian National Registry of Keratoconus (KCNRegⓇ). Demographic characteristics, patients' symptoms and their habits, as well as systemic and ocular disorders were documented. Clinical examinations included best corrected visual acuity (BCVA) and refractive error measurements, biomicroscopic examination, and corneal imaging. Results: In this case group, the frequency of mild, moderate, and severe KCN was 38%, 28%, and 34%, respectively. Parental consanguinity (odds ratio [OR] = 1.758, P = 0.029), positive familial history in patients' first degree (OR = 12.533, P < 0.001) and second degree (OR = 7.52, P < 0.001) relatives, vernal keratoconjunctivitis (OR = 7.510, P = 0.003), severe eye rubbing (OR = 10.625, P < 0.001), and systemic diseases including migraine, hypertension, and thyroid disease (OR = 6.828, P = 0.021) were found as associated factors for KCN. Lesser frequency of KCN was observed in patients with Fars ethnicity (OR = 0.583, P = 0.042), with higher levels of wealth indices (OR = 0.31, P < 0.001) and higher levels of education (OR = 0.18, P = 0.024). Conclusion: Severe eye rubbing, vernal keratoconjunctivitis, parental consanguinity and positive familial history of KCN, low socioeconomic status, and low levels of education were significantly associated with KCN in our study population.

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.

Torsion among Women with Acute Lower Abdominal Pain: A Retrospective Cross-Sectional Study.

Background: Lower abdominal or pelvic pain is a common complaint among women and one of the most challenging findings to evaluate. We performed the present study to construct a new algorithm for predicting the chance of ovarian torsion among women with acute lower abdominal pain. Methods: This diagnostic retrospective cross-sectional study was performed on all female individuals who were referred to Imam Hossein Medical Center, Tehran, Iran, with the chief complaint of acute lower abdominal pain, and underwent laparotomy between 2010 and 2016. Clinical and paraclinical findings were evaluated to construct a predictive model for ovarian torsion. The variables were compared in 2 groups. The first group included individuals with a final diagnosis of ovarian torsion and the second group included those individuals with any diagnosis other than ovarian torsion. All data were compared between these 2 groups using SPSS software Version 21 to find the related findings with a predictive value for ovarian torsion. Results: A total of 372 participants were evaluated, of whom 116 participants (31.2%) had ovarian torsion (case group) and 256 participants had other diagnoses for their lower abdominal pain (control group). Nausea and vomiting (p < 0.001), tenderness (p < 0.001), the size of ovarian mass (p = 0.004), and the percentage of polymorphonuclear (p < 0.001) showed significant relationships with ovarian torsion as the final diagnosis. Multiple logistic regression models were constructed to predict the factors affecting ovarian torsion, and a scoring system was designed to predict ovarian torsion, with a sensitivity of 77.59% (68.9%- 84.8%) and specificity of 74.61% (68.8% 79.8%). Conclusion: The proposed model is suitable for predicting ovarian torsion and its necessary information is readily available from individuals' history, examination findings, laboratory results, and an ultrasound exam.

A new decision making model for diagnosing acute appendicitis among non-pregnant women and its comparison with alvarado scoring system.

Background: Although acute appendicitis is a common problem, it remains a difficult diagnosis to establish, particularly among females of reproductive age. The present study was conducted to devise a new decision making model for diagnosing acute appendicitis in non-pregnant women. Methods: The present study was a retrospective study consisting of women who had undergone an appendectomy between 2007 and 2015 at the emergency department of Imam Hossein Medical Center, Tehran, Iran. The inclusion criteria were being a female, presenting with abdominal pain, being a suspected case of acute appendicitis, and undergoing an emergency appendectomy. A classification and regression tree (CART) analysis was performed to partition exam and laboratory data obtained from these patients into homogeneous groups in order to develop a prediction rule for appendicitis diagnosis. Results: The study population included 433 non pregnant women who underwent emergency operations with a preliminary diagnosis of acute appendicis. Out of these patients, 295 patients (68.1%) were appendicitis positive based on the pathology exam results, while 138 patients had a normal appendix, indicating a negative appendectomy rate of 31.8%. The final devised CART model included hemoglobin level, PMN count, age, and history of abdominal incision and yielded a sensitivity of 82.7% and specificity of 55.8%, which were better than Alvarado prediction results for the Asian population. Conclusion: We have devised a simple and cost effective prediction model for predicting the outcome among non-pregnant women undergoing emergency appendectomy operation with good sensitivity and specificity compared to the Alvarado model.

Retinal Vascular Abnormalities in Different Types of Inherited Retinal Dystrophies Assessed by Optical Coherence Tomography Angiography.

PURPOSE: To investigate the retinal vascular characteristics among patients with different types of inherited retinal dystrophies (IRDs). METHODS: This comparative cross-sectional study was conducted on 59 genetically confirmed cases of IRD including 37 patients with retinitis pigmentosa (RP) (74 eyes), 13 patients with Stargardt disease (STGD) (26 eyes), and 9 patients with cone-rod dystrophy (CRD) (18 eyes). Both eyes of 50 age- and sex-matched healthy individuals were investigated as controls. All participants underwent optical coherence tomography angiography to investigate the vascular densities (VDs) of superficial and deep capillary plexus (SCP and DCP) as well as foveal avascular zone area. RESULTS: In RP, significantly lower VD in whole image (P = 0.001 for DCP), fovea (P = 0.038 for SCP), parafovea (P < 0.001 for SCP and DCP), and perifovea (P < 0.001 for SCP and DCP) was observed compared to controls. In STGD, VD of parafovea (P = 0.012 for SCP and P = 0.001 for DCP) and fovea (P = 0.016 for DCP) was significantly lower than controls. In CRD, the VD of parafovea (P = 0.025 for DCP) was significantly lower than controls. Whole image density was significantly lower in RP compared to STGD (P < 0.001 for SCP) and CRD (P = 0.037 for SCP). VD in parafovea (P = 0.005 for SCP) and perifovea (P < 0.001 for SCP and DCP) regions was significantly lower in RP compared with STGD. Also, foveal VD in STGD was significantly lower than RP (P = 0.023 for DCP). CONCLUSION: Our study demonstrated lower VDs in three different IRDs including RP, STGD, and CRD compared to healthy controls. Changes were more dominant in RP patients.

Management of Consecutive Exotropia.

PURPOSE: To determine the clinical characteristics and surgical outcomes of medial rectus (MR) advancement with or without lateral rectus (LR) recession in patients with consecutive exotropia. METHODS: This interventional case series was performed on patients with consecutive exotropia of more than 15 prism diopters (PD) at least 6 months after the esotropia surgery. All patients were operated using either unilateral or bilateral MR muscle advancement with or without simultaneous LR recession. Ocular deviation at far and near distances, adduction limitation, and exoshift were investigated at the follow-ups of 1 week, as well as 1, 3, and 6 months after the surgery. Operation was considered successful when the postoperative far deviation was <10 PD. RESULTS: Thirty patients were evaluated. The mean amount of MR advancement was 5.69 ± 1.33 mm with the mean dose response of 4.7 ± 3.3 and 4.55 ± 4.01 PD at 3 and 6-month follow-ups, respectively. Success rate was reduced from 93% at week 1 to 73% at month 6 due to postoperative exodrift, especially during the first 3 months. Preoperative exotropia was the only contributing factor in our study. CONCLUSIONS: MR advancement was an effective surgical method for consecutive exotropia correction, especially in cases with MR underaction. Bilateral MR advancement and/or LR recession are suggested in cases with higher preoperative exodeviation. The presence of postoperative exodrift indicates longer follow-ups for patients.

Lateral rectus resection versus lateral rectus plication in patients with residual Esotropia.

This study was aimed to compare the surgical outcomes of lateral rectus plication and resection techniques on patients with residual esotropia. In this randomized clinical trial, a total of 57 patients with residual esotropia (31 females) who were candidates for lateral rectus resection were randomized into plication (n = 27) and resection (n = 30) groups. The inclusion criteria were residual Esotropia after uni- or bilateral medial rectus recession. Subjects with a history of prematurity, lack of central fixation, extraocular muscle palsy, systemic, ocular disorders, history of lateral rectus operation, or follow up less than 3 months were excluded. Ophthalmic examinations were conducted preoperatively and at 1, 3-, and 6-month follow-ups. Surgical success rate was considered postoperative eso- or exotropia ≤10 pd. Based on the study results, there was no statistically significant difference between the two groups regarding the pre- (plication: 27.9 ± 9.8 pd and resection: 26.4 ± 7.6 pd; P = .52) and postoperative mean angle of deviation at far distance in month 3 (plication: 5.1 ± 7.1 pd and resection: 5.4 ± 3.2 pd; P = .82). Postoperative success rate also showed similarity between these two groups at all postoperative follow-ups of months 1, 3, and 6.There was no statistically significant difference between dose responses of these groups in uni- or bilateral operations. In conclusion, lateral rectus plication and resection showed statistically similar results. Each surgical method could be selected according to surgeon's skill and comfort. We recommend plication method for patients with postoperative probability of anterior segment ischemia.

Motor and Sensory Outcomes of Infantile Exotropia: A 10-Year Study (2008-2017).

PURPOSE: We aimed to determine the long-term motor and sensory outcomes of patients with infantile exotropia. METHODS: In this longitudinal retrospective (historical cohort) study, the records of 76 patients with infantile exotropia were Studied. Subjects with constant exotropia manifesting before the age of 1 year who were at least 5 years old at recruitment time between 2008 and 2017 were included. RESULTS: The medical records of 26 patients were excluded due to not participating in follow-up examinations or having incomplete records. In total, 54 infantile exotropic patients (51.9% male) with a mean age of 11.1 ± 6.8 years and follow-up of 4.99 ± 3.58 years were studied. Postoperative sensory outcomes (central stereopsis [<60 sec/arc], peripheral fusion [60-3,000 sec/arc], and non-stereopsis [>3,000 sec/arc]) were observed in 38.9%, 38.9%, and 21.2% of patients, respectively. In terms of postoperative motor outcomes, 69%, 24%, and 7% were achieved as orthophoria, residual exotropia, and consecutive esotropia, respectively. Patients with a higher surgical age (p = 0.022) and better visual acuity (p = 0.004) had significantly better sensory outcomes, while higher preoperative deviation resulted in more suppression (p = 0.039, rs = 0.218). CONCLUSIONS: With rates of 69% for motor success and 78.8% for sensory success, surgical outcomes of infantile exotropic patients seems to be favorable. Further studies are recommended to verify our findings.

The myo-inositol effect on the oocyte quality and fertilization rate among women with polycystic ovary syndrome undergoing assisted reproductive technology cycles: a randomized clinical trial.

PURPOSE: The aim of the present study was to evaluate the effect of myo-Inositol administration on oocyte quality, fertilization rate and embryo quality in patients with PCOS during assisted reproductive technology (ART) cycles. METHODS: Fifty infertile PCOS patients were randomly designated in two groups. In the study group, patients received daily doses of 4 g myo-Inositol combined with 400 mg folic acid and in the control group patients received only 400 mg folic acid from 1 month before starting the antagonist cycle until the day of ovum pick up. Oocyte and embryo qualities were assessed according to European Society of Human Reproduction and Embryology (ESHRE) guidelines. The gene expression of PGK1, RGS2 and CDC42 as a factor of oocyte quality in granulosa cells was analyzed using real-time RT-PCR. Levels of total antioxidant capacity (TAC) and reactive oxygen species (ROS) were evaluated by chemiluminescence assay in follicular fluid. RESULTS: The percentage of metaphase II oocyte, fertilization rate and embryo quality significantly improved in the study group (p < 0.05), but the number of retrieved oocytes and follicle count were not statistically different between groups. Furthermore, the gene expression of PGK1, RGS2 and CDC42 was significantly higher in the study group (p < 0.05) but no differences were found between two groups in terms of TAC and ROS levels. CONCLUSIONS: The present study findings suggest that myo-Inositol alters the gene expression in granulosa cells and improves oocyte and embryo quality among PCOS patients undergoing ART.

Comparative Assessment of Tear Function Tests, Tear Osmolarity, and Conjunctival Impression Cytology between Patients with Pterygium and Healthy Eyes.

PURPOSE: To compare histologic abnormalities of tear film and tear osmolarity between normal eyes and eyes with pterygium. METHODS: This was a prospective, hospital-based, case-control study involving 95 patients (65 men, 30 women) with unilateral pterygium. The tear meniscus height (TMH), Schirmer's test-1 (SCH-1) score, Rose Bengal staining (RBS) score, tear film breakup time (TBUT), tear osmolarity (TO), and conjunctival impression cytology (CIC) were assessed in both eyes. The Chi-square and Student's t-tests were used to compare the results between the two groups. P values <0.05 were considered statistically significant. RESULTS: The mean patient age was 50.9 years, with the largest age group being the 45-55 year-old bracket across both genders. Most patients (82.1%) had nasal pterygium, and 80% were involved in outside activities. The mean assessment values in the case and control groups were as follows: TMH, 0.21 vs. 0.24 mm; SCH-1, 13.2 vs. 17.8 mm; RBS, 4.38 vs. 2.51 points; TBUT, 8.7 vs. 13.2 seconds; TO, 306 vs. 299 mOsm/L (P < 0.001 in all cases). The proportions of abnormal assessment values in the case and control groups were as follows: TMH, 82.1% vs. 3.16%; SCH-1, 20% vs. 2.1%; RBS, 30.53% vs. 4.22%; TBUT, 61.05% vs. 6.3%; TO, 10.52% vs. 1.05%; CIC, 33.7% vs. 7.37% (P < 0.05 for all comparisons). CONCLUSION: This study showed that the quantity and quality of tear film, as well as the number of goblet cells, decreased, but the tear osmolarity increased in eyes with pterygium. Furthermore, the TMH, RBS results, TBUT, and CIC have more precise state of the patient's tear condition with the disease of the pterygium.

Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification.

PURPOSE: To evaluate the therapeutic efficacy of intradiscal ozone injection in reducing pain and improving patients' performance in different types of intervertebral disc herniation based on Michigan State University (MSU) classification. PATIENTS AND METHODS: Consecutive patients with low back pain and radiculopathy treated in our center with ozone chemonucleolysis from May 2017 through to January 2018 entered the study. Patients had a disc herniation classified as group 1-A, 2-A, 1-B, 2-B, 1-C, 2-C, 1-AB or 2-AB based on MSU classification in magnetic resonance imaging. In all patients entering the study the severity of pain was recorded according to the visual analog scale criteria before and one and three months after the end of treatment. Oswestry Low Back Pain Disability Index (ODI) was used to compare patients' performance before and after the treatment. RESULTS: In total 128 patients (60 females and 68 males) with mean age of 40.1 ± 10.7 entered the study. The patients were divided into eight groups based on MSU classification each including 16 patients. The reduction of pain severity and ODI score compared to baseline was statistically significant in all groups both in the first month and the third month after treatment. There was also a statistically significant difference between groups regarding the reduction of pain and ODI score indicating significantly worse treatment outcomes in groups 1-C, 2-C and 2-AB. CONCLUSION: Based on our findings it seems that MSU classification can be used in patients' selection to achieve the best treatment outcome after intradiscal ozone injection among patients with lumbar disc herniation.

A New Approach to an Old Concept for Reducing Shoulder Pain Caused by Gynecological Laparoscopy.

BACKGROUND: The purpose of this study was to introduce a technique to extract the remaining peritoneal gas in order to improve the post-laparoscopic shoulder pain. METHODS: This study included 12 patients undergoing laparoscopic gynecologic procedures between February and March 2016 in Minimally Invasive Techniques Research Center, Pars Hospital, Tehran, Iran. For complete suction of the air from abdominal cavity, the air was first vacuumed from the pelvic cavity in Trendelenburg position and then the patients were put in anti-Trendelenburg position. In this position, as the remaining gas was shifting toward subdiaphragmatic area, the suction tube was shifted to a position next to the camera canal and the remaining air was suctioned. A 10 point visual analogue scale was used to measure the severity of patients' post-operative shoulder pain. RESULTS: The mean VAS for shoulder pain was 0.8±1.7 4 hr post-surgery. At 12 hr post-surgery, the mean VAS was 0.8±1.5. At 24 hr post-surgery, the mean VAS for shoulder pain was 0.3±0.8. Finally, 48 hr post-surgery, the VAS score for all patients was zero. CONCLUSION: Our approach for emptying the abdominal cavity from residual gas after laparoscopic procedures seems to be useful in preventing post-operative shoulder pain among patients undergoing gynecological laparoscopic surgeries. Further studies are suggested to compare the effect of our proposed method with other methods.

Visual acuity, endothelial cell density and polymegathism after iris-fixated lens implantation.

PURPOSE: The purpose of this study was to evaluate the visual acuity as well as endothelial cell density (ECD) and polymegathism after iris-fixated lens (Artiflex® AC 401) implantation for correction of moderate to high myopia. PATIENTS AND METHODS: In this retrospective cross-sectional study, 55 eyes from 29 patients undergoing iris-fixated lens implantation for correction of myopia (-5.00 to -15.00 D) from 2007 to 2014 were evaluated. Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, ECD and polymegathism (coefficient of variation [CV] in the sizes of endothelial cells) were measured preoperatively and 6 months postoperatively. RESULTS: In the sixth month of follow-up, the uncorrected vision acuity was 20/25 or better in 81.5% of the eyes. The best-corrected visual acuity was 20/30 or better in 96.3% of the eyes, and more than 92% of the eyes had a refraction score of ±1 D from the target refraction. The mean corneal ECD of patients before surgery was 2,803±339 cells/mm2, which changed to 2,744±369 cells/mm2 six months after surgery (p=0.142). CV in the sizes of endothelial cells before the surgery was 25.7%±7.1% and six months after surgery it was 25.9%±5.4% (p=0.857). CONCLUSION: Artiflex iris-fixated lens implantation is a suitable and predictable method for correction of moderate to high myopia. There was no statistically significant change in ECD and polymegathism (CV in the sizes of endothelial cells) after 6 months of follow-up.

The relationship between abduction deficit and reoperation among patients with infantile esotropia.

AIM: To determine the relationship between abduction deficit and reoperation among patients with infantile esotropia (IET). METHODS: The records of 216 patients (432 eyes) with IET who underwent surgery, from 2010 to 2015 were studied. Patients with IET whose deviation appeared before 6mo of age and had stable preoperative deviation in two examinations with at least 2wk apart and a minimum 3mo postoperative follow up were included. Cases with early onset accommodative esotropia, congenital cataract, retinopathy of prematurity (ROP), manifest nystagmus, fundus lesions, neurologic and ophthalmic anomalies, 6th nerve palsy and Duane's syndrome were excluded. Preoperative abduction deficit was considered from -1 to -3 grading scale. Three months after surgery, children were classified into no-need reoperation [deviation≤15 prism diopters (PD)], and need-reoperation groups (deviation>15 PD). RESULTS: In this retrospective study, 117 female and 99 male patients with the mean surgical age of 4.7±6.4y were included. Reoperation rate was 33.3% and 16.0% in IET patients with and without abduction deficit, respectively in patients who had a history of late surgery. Abduction deficit increased the odds of reoperation by 82% [OR=1.82, 95% confidence interval (CI) =1.05 to 3.19, P=0.003] in patients who had a history of late surgery (>2 years old, P=0.021). Abduction deficit was improved significantly after operation (P<0.001). CONCLUSION: Based on our results, abduction deficit can be considered as a risk factor of reoperation in IET patients who are operated at the age of more than 2y.

Vitamin B12 Deficiency as a Cause of Neurotrophic Keratopathy.

INTRODUCTION: Neurotrophic keratitis is a rare degenerative corneal disease caused by an impairment of trigeminal corneal innervation, leading to a decrease or absence of corneal sensation. Here, we present a case of neurotrophic keratopathy caused by B12 deficiency in a 34 years old man who had a progressive decrease in visual acuity and corneal involvement since 3 months before being referred to our ophthalmology clinic. RESULT AND DISCUSSION: Based on our clinical findings and with the diagnosis of B12 deficiency we started B12 treatment for the patient. After 3 weeks the patient showed a dramatic response with corneal sensation reversal, an increase of visual acuity, improved neurotrophic keratopathy and significantly improved neurological findings. To the best of our knowledge, there is no report regarding vitamin B12 deficiency induced keratopathy and this is the first report that describes this aspect of vitamin B12 deficiency.

Renal Hemosiderosis among Iranian Transfusion Dependent ß-Thalassemia Major Patients.

Background: In recent years, the success in management of thalassemic patients, has allowed for some previously unrecognized complications including renal abnormalities to emerge. This prospective study aimed to investigate kidney iron overload by means of MRI T2* and also renal function based on laboratory tests for early markers of glomerular and tubular dysfunction among adult Iranian transfusion-dependent thalassemia major patients. Subjects and Methods: Two-hundred and two patients with transfusion-dependent ß-thalassemia major were included in this study in Zafar Adult Thalassemia Center, Tehran, Iran. For all patients, kidney MRI T2* as well as evaluation of BUN, creatinine, uric acid, calcium, phosphorus, sodium (Na), potassium (K), total protein, albumin, cystatin C, serum ferritin ß2-microglobulin, NAG (N-acetyl-beta-D-Glucosaminidase), and urine protein were performed. Results: One-hundred and fourteen female and 88 male transfusion-dependent ß-thalassemia major patients with mean age of 30.1 ± 9.4 participated in the present study. We found that 77.7% of our patients had kidney hemosiderosis based on MRI T2*. Also, 67 patients (33.2%) had elevation of serum cystatin C, and 104 patients (51.5%) had reduced estimated glomerular filtration rate (e-GFR). Increased urinary excretion of NAG and hypercalciuria were found in 50% and 79.2% of participants, respectively. Conclusion: Renal hemosiderosis and asymptomatic renal dysfunction are prevalent among transfusion- dependent ß-thalassemia major patients which necessitate regular screening with early markers of glomerular and tubular dysfunction. Further studies in order to investigate the correlation between renal hemosiderosis and early markers of kidney dysfunction among these patients are recommended.

T2* Magnetic Resonance Imaging Study of Pancreatic Iron Overload and its Relation With the Diabetic State in Thalassemic Patients.

The present study was performed to evaluate pancreatic hemosiderosis by means of magnetic resonance imaging (MRI) T2* and its relation to the diabetic state in thalassemic patients. One hundred thirty transfusion-dependent thalassemic patients from Zafar adult thalassemia clinic, Tehran, Iran, were enrolled in the study. Data such as age, type of thalassemia, age at diagnosis, transfusion duration, ferritin level, and fasting blood sugar results were gathered. Pancreatic MRI T2* was performed for all patients. One hundred four thalassemic patients with no sign of diabetes mellitus and 26 thalassemic patients with diabetes mellitus entered the study. Out of a total of 130 patients, 102 had pancreatic hemosiderosis. Among them, 23 of 26 diabetic patients (88.5%) and 79 of 104 nondiabetic patients (76%) showed pancreatic hemosiderosis, indicating no statistically significant difference between the 2 groups. The mean pancreatic MRI T2* relaxation time for all patients was 13.99±12.43 ms. The mean relaxation was 13.62±8.38 and 14.08±13.28 ms for diabetic and nondiabetic patients, respectively, showing no statistical difference (P=0.202). In conclusion, we did not find a significant difference between diabetic and nondiabetic thalassemic patients regarding the MRI T2* relaxation time readings or the rate of pancreatic hemosiderosis. We recommend performing studies with a higher sample size and including patients from different age groups to further evaluate the role of T2* MRI of pancreatic iron overload and its relation with the diabetic state in thalassemic patients.