Environmental Surveillance of Poliovirus and Non-polio Enteroviruses in Iran, 2017-2023: First Report of Imported Wild Poliovirus Type 1 Since 2000.

In Iran, which is at high risk of the Wild Poliovirus (WPV) and Vaccine-Derived Poliovirus (VDPV) importation due to its neighborhood with two polio endemic countries, Pakistan and Afghanistan, Environmental Surveillance (ES) was established in November 2017. Sistan-Balouchestan province was chosen for the ES due to its vicinity with Pakistan and Afghanistan. Five sewage collection sites in 4 cities (Zahedan, Zabol, Chabahar and Konarak) were selected in the high-risk areas. Since the establishment of ES in November 2017 till the end of 2023, 364 sewage specimens were collected and analyzed. The ES detected polioviruses which have the highest significance for polio eradication program, that is, Wild Poliovirus type 1 (WPV1) and Poliovirus type 2 (PV2). In April and May 2019, three of 364 (0.8%) sewage specimens from Konarak were positive for imported WPV1. According to phylogenetic analysis, they were highly related to WPV1 circulating in Karachi (Sindh province) in Pakistan. PV2 was also detected in 5.7% (21/364) of the sewage specimens, most of which proved to be imported from the neighboring countries. Of 21 isolated PV2s, 7 were VDPV2, of which 5 proved to be imported from the neighboring countries as there was VDPV2 circulating in Pakistan at the time of sampling, and 2 were ambiguous VDPVs (aVDPV) with unknown source. According to the findings of this study, as long as WPV1 and VDPV2 outbreaks are detected in Iran's neighboring countries, there is a definite need for continuation and expansion of the environmental surveillance.

Plateau Iris: A Review.

Purpose: To review the concept of plateau iris and summarize the recent evidence on its diagnosis and management. Methods: This is a narrative review on the plateau iris. A literature review was conducted in PubMed, Google Scholar, and Scopus databases using keywords: angle-closure glaucoma, glaucoma, nonpupillary block glaucoma, plateau iris, and plateau iris management. Results: This review defined the current knowledge about plateau iris. First of all, the anatomy and epidemiology were discussed. Then, we outlined the available evidence on the diagnosis of plateau iris and its differential diagnosis. Conclusively, the treatment options were mentioned. Conclusions: Plateau iris is a condition in which nonpupillary block mechanisms are responsible for intraocular pressure elevation and angle closure attack when a patent peripheral iridotomy has removed the relative pupillary block. An anteriorly positioned ciliary body causes mechanical obstruction of trabecular meshwork in these patients. It is usually seen in younger patients with angle closure and is diagnosed by gonioscopic examination and imaging modalities such as Ultrasound biomicroscopy. Despite the known mechanism of plateau iris, there is no consensus over treatment. Low-dose pilocarpine and Argon laser peripheral iridoplasty are nonsurgical treatments for these patients, but their effects are short-term. Cataract extraction with/without endocyclophotocoagulation (ECP), endocycloplasty, excisional goniotomy, and transscleral cyclophotocoagulation are alternative treatments. Patients should be examined periodically for further progression or recurrence of plateau iris. In cases of glaucoma unresponsive to conventional medical treatments, surgical treatments such as trabeculectomy and drainage devices should be considered.

One-year outcomes of combined phacoemulsification and viscogoniosynechialysis with and without endoscopic cyclophotocoagulation in primary angle-closure glaucoma.

PURPOSE: To compare the outcomes of combined phacoemulsification and viscogoniosynechialysis (VGSL) with and without endoscopic cyclophtocoagulation (ECP) in primary angle-closure glaucoma (PACG). METHODS: In this prospective interventional case series 52 eyes of 50 patients were enrolled. Twenty-seven eyes underwent combined phacoemulsification and VGSL (PV group) and 25 eyes underwent the same procedure plus circumferential ECP (PVE group). All eyes were followed 1 day, 1 week, 3 months, 6 months, and 1 year after the procedure. Intraocular pressure and antiglaucoma medications were compared between and within groups using generalized estimating equations. Kaplan-Meier survival analysis was carried out to compare intensity to failure between groups. RESULTS: The mean ± SD age was 63.23 ± 6.87 years and 50% of the cases were male in the entire group. Intraocular pressure (IOP) and antiglaucoma medications were significantly reduced at all time points in comparison with the baseline in both groups (p < 0.05). There was no significant difference between groups in either IOP or medications at specific time points (p > 0.05). One eye in each group developed a fibrinous reaction in the postoperative period. There was no statistically significant difference between groups regarding the intensity to failure (P = 0.169). CONCLUSION: There were no significant differences in IOP and medication reduction between groups. Also, the complications were comparable between groups.

The national health program for vitamin D supplementation in a developing country.

BACKGROUND: Previous studies have reported a high frequency of vitamin D deficiency (VDD) among different age groups in Iran. AIMS: In this study, the current coverage, status of vitamin D supplement taking, and program efficacy have been evaluated by the Office of Nutrition Department Society in Iran since 2014. METHODS: This study was conducted in collaboration with the International UNESCO center for Health-Related Basic Sciences and Human Nutrition and the Office of Nutrition Department Society. Sixty three medical universities were included in the current study to calculate the availability, accessibility and acceptability coverages. Furthermore, 3 medical universities including Mashhad (MUMS), Qom (QUMS) and Zahedan (ZAUMS) University of Medical Sciences were selected based on the results of the National Integrated Micronutrient Survey 2012 (NIMS-II study), in order to assess the status of vitamin D supplement intake in all age ranges. RESULTS: Quantitative analysis showed that availability coverage was 74.96% and 77.56% and accessibility was 80.70% and 83.26% in elderly and middle-aged subjects, respectively in 2018. The acceptability was approximately 43.7% and 43.9% among elderly and middle-aged participants, respectively. The availability and acceptability coverage was 80.99% and 85.0% among students in high schools. The mean vitamin D supplement uptake frequency was 27.0% (n = 387); 20.7% and 29.2% in rural and urban area, respectively (P = 0.001). The results showed that there was no significant difference in serum vitamin D levels between urban (20.41 ± 6.43 ng/ml) and rural areas, (P = 0.887). There was no significant difference in the serum vitamin D concentrations between men and women (P = 0.461). CONCLUSIONS: The frequency of taking vitamin D supplements was 27.0% in Iran in 2018. The frequency of taking of vitamin D supplements among vitamin D deficient group (serum vitamin D levels <19.99 ng/ml) was 43.6%. Lack of knowledge was the most important reason for not taking vitamin D supplement. Moreover, the serum vitamin D levels have increased in subjects aged 18-30 years old after the implementation of the vitamin D supplementary program.

Deep Learning-Based Classification of Subtypes of Primary Angle-Closure Disease With Anterior Segment Optical Coherence Tomography.

PRCIS: We developed a deep learning-based classifier that can discriminate primary angle closure suspects (PACS), primary angle closure (PAC)/primary angle closure glaucoma (PACG), and also control eyes with open angle with acceptable accuracy. PURPOSE: To develop a deep learning-based classifier for differentiating subtypes of primary angle closure disease, including PACS and PAC/PACG, and also normal control eyes. MATERIALS AND METHODS: Anterior segment optical coherence tomography images were used for analysis with 5 different networks including MnasNet, MobileNet, ResNet18, ResNet50, and EfficientNet. The data set was split with randomization performed at the patient level into a training plus validation set (85%), and a test data set (15%). Then 4-fold cross-validation was used to train the model. In each mentioned architecture, the networks were trained with original and cropped images. Also, the analyses were carried out for single images and images grouped on the patient level (case-based). Then majority voting was applied to the determination of the final prediction. RESULTS: A total of 1616 images of normal eyes (87 eyes), 1055 images of PACS (66 eyes), and 1076 images of PAC/PACG (66 eyes) eyes were included in the analysis. The mean ± SD age was 51.76 ± 15.15 years and 48.3% were males. MobileNet had the best performance in the model, in which both original and cropped images were used. The accuracy of MobileNet for detecting normal, PACS, and PAC/PACG eyes was 0.99 ± 0.00, 0.77 ± 0.02, and 0.77 ± 0.03, respectively. By running MobileNet in a case-based classification approach, the accuracy improved and reached 0.95 ± 0.03, 0.83 ± 0.06, and 0.81 ± 0.05, respectively. For detecting the open angle, PACS, and PAC/PACG, the MobileNet classifier achieved an area under the curve of 1, 0.906, and 0.872, respectively, on the test data set. CONCLUSION: The MobileNet-based classifier can detect normal, PACS, and PAC/PACG eyes with acceptable accuracy based on anterior segment optical coherence tomography images.

Study Factors Involved in Maternal Deaths Attributed to COVID-19 in a Disadvantaged Area in Southeast of Iran.

Objective: It is a fact that coronavirus disease of 2019 (COVID-19) infection mortality rate is high, but the question is "what is the role of other factors in maternal death with COVID-19?" The present study aimed to understand the factors that prevent women from timely use of healthcare services and also the potential weaknesses of the healthcare system that cause the lack of quality healthcare services for women. Materials and methods: This case-series study was performed in the southeast of Iran. In total, 12 cases of maternal deaths attributed to COVID-19 were identified through the Iranian Maternal Mortality Surveillance System. The required information was collected through existing verbal autopsy data sets. In some cases, the family members had to be re-contacted and healthcare workers were asked to supply the missing information. The root cause analysis method was employed for data analysis. Results: From March 2020 to March 2021, the deaths of 12 women were attributed to COVID-19. The majority of these women lived in rural areas (58%) and had a secondary school education level or less (83.3%). The contributing factors were divided into three categories: barriers at the community level (no prenatal care, lack of trust, lack of recognition of the severity of disease, and attribution of symptoms to something else), at the primary health system level, and at the hospital level (fear of staff of being infected, non-compliance with guidelines, lack of team working, and problem with telehealth). Conclusion: The socio-cultural context and unmet healthcare needs hinder the utilization of available services. Moreover, factors at the level of the healthcare system prevent the timely detection and referral of women with COVID-19 to receive quality healthcare services. Using telehealth also did not help to appropriately triage pregnant women.

The thickness of the outer retina in the macula and circumpapillary area in patients with unilateral advanced glaucoma.

PURPOSE: To compare outer macular and retinal thickness in the circumpapillary area in unilateral advanced glaucomatous eyes to the normal or mild glaucomatous fellow eyes. METHODS: Seventy-eight eyes of 39 patients with unilateral advanced glaucoma (mean deviation (MD) worse than -12.00 dB based on visual field 24-2) were included in this cross-sectional study as the cases. The healthy or mild glaucomatous fellow eyes were enrolled as the control group. All eyes underwent optical coherence tomography of the macula and circumpapillary retina by Topcon DRI Triton (Topcon, Tokyo, Japan). Ganglion cell layer 2+ was considered as the inner retina. Total retinal thickness minus the thickness of the inner retina was considered as the outer retina. Comparison between groups was done by paired-sample sign test. The correlation between structural and functional parameters was evaluated by a partial correlation coefficient. RESULTS: Seventeen (43.6%), 15 (38.5%), and 7 (17.9%) patients had pseudoexfoliation, primary angle-closure, and primary open-angle glaucoma, respectively. The mean age was 62.69 ± 12.00 years. Thirty-three (84.6%) patients were male. The outer retinal thickness in the circumpapillary area was higher in temporal, superior, and inferior quadrants (p < 0.05). The outer macula in different parafoveal and perifoveal quadrants was also thicker (p < 0.05). Average outer parafoveal thickness in the case group had a significant negative correlation with MD (r = -0.339; p = 0.035). CONCLUSION: Advanced glaucomatous eyes had a thicker outer retina in the macula and circumpapillary area. There was a significant negative correlation between outer perifoveal thickness and MD.

Six-month outcomes of combined conventional needle goniotomy and phacoemulsification in eyes with early to moderate primary open-angle and pseudoexfoliation glaucoma and ocular hypertension.

Purpose: Angle-based surgeries for the treatment of open-angle glaucoma have gained popularity in recent years. This study aimed to evaluate the efficacy of combined phacoemulsification and goniotomy in primary open-angle and pseudoexfoliation glaucoma (POAG and PXG) and ocular hypertension (OHTN). Methods: In this interventional case series in the setting of the Glaucoma Service at the Farabi Eye Hospital, 32 eyes of 30 patients with early-to-moderate POAG and PXG and OHTN were enrolled. All eyes underwent combined phacoemulsification and needle goniotomy. Intraocular pressure (IOP) and the number of antiglaucoma medications as well as demographic data were recorded at baseline and one day, one week, one month, three months, and six months after the surgery. Generalized Estimating Equation (GEE) was used to compare the values of IOP and the number of medications at different time points. Kaplan-Meier graph was used to demonstrate the survival status of the eyes. Results: Mean IOP at baseline was 21.8 ± 4.6 mmHg on mean 1.2 ± 1.5 topical medications. There was a 25.2% (16.3 ± 4.5 mmHg) and 32.1% (14.8 ± 3.9 mmHg) reduction in IOP at three and six months after procedure, respectively (P < 0.001). Meanwhile, the decline in medications was 66.7% (0.4 ± 0.9) and 50.0% (0.6 ± 1.1) at the same time points (P = 0.002 and P = 0.048, respectively). Post-operative complications were clot hyphema (n = 1, 3.1%), fibrinous inflammation (n = 1, 3.1%) and distorted pupil (n = 2, 6.3%). Conclusion: Combined phacoemulsification and needle goniotomy as a procedure for mild and moderate POAG and PXG and OHTN is as effective as other modified goniotomies in the setting of minimally invasive glaucoma surgeries (MIGS).

The role of optical coherence tomography angiography in moderate and advanced primary open-angle glaucoma.

PURPOSE: To evaluate the relationship between structure and function in moderate and advanced primary open-angle glaucoma (POAG) and to determine the accuracy of structure and vasculature for discriminating moderate from advanced POAG. METHODS: In this cross-sectional study, 25 eyes with moderate and 40 eyes with advanced POAG were enrolled. All eyes underwent measurement of the thickness of circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell complex (GCC), and optical coherence tomography angiography (OCTA) of the optic nerve head (ONH) and macula. Visual field (VF) was evaluated by Swedish interactive threshold algorithm and 24-2 and 10-2 patterns. The correlation between structure and vasculature and the mean deviation (MD) of the VFs was evaluated by a partial correlation coefficient. The area under the receiver operating characteristic curve (AUC) was applied for assessing the power of variables for discrimination moderate from advanced POAG. RESULTS: Including all eyes, whole image vessel density (wiVD) of the ONH area, and vessel density (VD) in the inferior quadrant of perifovea were the parameters with significant correlation with the mean deviation (MD) of the VF 24-2 in OCTA of the ONH and macula (r = .649 and .397; p < .05). The greatest AUCs for discriminating moderate and advanced POAG belonged to VD of the inferior hemifield of ONH area (.886; 95% CI (.805, .967)), and VD in the inferior quadrant of perifovea (.833; 95% CI (.736, .930)) without statistically significant difference (.886 Versus .833; p = .601). CONCLUSION: Among vascular parameters of the ONH area, wiVD had the strongest correlation with the MD of the VF 24-2 while VD of the inferior hemifield of the ONH area had the greatest AUC for discriminating moderate and advanced POAG. Vessel density in the inferior quadrant of perifovea had a significant correlation with the MD of VF 24-2 and also the greatest AUC for discriminating moderate and advanced POAG.

Is nutritional functional diversity in the rural food and nutrition system associated with food security and nutrient adequacy? A case study of rural areas of Zahedan district, Iran.

BACKGROUND: An overlooked problem in food and nutrition system analysis is assuring adequate diversity for a healthy diet. Little is known about nutrient diversity in food and nutrition systems and how it transmits to dietary diversity. Nutritional functional diversity (NFD) is a metric that describes diversity in providing nutrients from farm to market and the consumption level. The objective of this study is to determine the NFD score at different stages of the rural food and nutrition system, including household's agricultural and home production, domestic food processing, purchased food, and diet. It also aims to explore the association between NFD and nutrient adequacy, food security, and anthropometric indicators. METHODS: A cross-sectional study was conducted on 321 households in 6 villages of Zahedan district. The NFD score was measured at three subsystems (production, processing, and consumption) of the food and nutrition system. Household food security, mean adequacy ratio (MAR), and anthropometrics of the household's head were measured to assess the association between NFD and food and nutrition indicators. Linear and bivariate statistical techniques were applied to study the associations between variables. RESULTS: In the rural food and nutrition system, the food purchased from the city plays the main role in the households NFD score. Their contribution to total NFD was twice that of the food items purchased from the village. The NFD score of homestead production and households food processing was found to be five times less than those of food purchased from cities. The food insecure households had significantly lower NFD scores for food purchased from the city and higher NFD scores for purchased food items from the rural market and native wild vegetable consumption. A strong and positive relationship was observed between NFD of food items purchased from the city and households'MAR. No significant association was found between the NFD score of homestead production, processing, and dependent variables, i.e. food insecurity, MAR, and household head anthropometrics. CONCLUSION: NFD score, as a relatively new metric, could help in determining diversity from farm to diet and identifying the gaps to plan appropriate interventions for improving diversity in the local food system.

Epidemiological and clinical risk factors related to severe COVID-19 in Iran: a multi-center study.

BACKGROUND: Iran was one of the first countries to be affected by COVID-19. Identifying factors associated with the severity of COVID-19 is effective in disease management. This study investigated the epidemiological and clinical features and factors related to the severity of COVID-19 in one of the less privileged areas in Iran. METHODS: In a multi-center study, all patients admitted to Zahedan University of Medical Sciences hospitals in southeastern Iran were investigated from February 29 to April 31, 2020. Demographic, epidemiological, and clinical data of patients were extracted from medical records. Bivariate and multivariate logistic regression models were used to explore the risk factors associated with the severity of COVID-19. RESULTS: Among the 413 patients, 55.5% were male, and 145 (35.10%) were in a severe condition at admission time. Multivariate analysis showed that the adjusted odds of the disease severity increased in patients with older age (OR 2.27; 95% CI 1.41-3.65), substance abuse (OR 2.49; 95% CI 1.14-5.43), having one underlying disease (OR 1.52; 95% CI 0.90-2.55), having two underlying disease (OR 2.31; 95% CI 1.19-4.50), and having three or more underlying disease (OR 2.60; 95% CI 1.19-5.66). CONCLUSIONS: COVID-19 was more severe in older patients, patients with a history of substance abuse, and patients with the underlying disease. Understanding the factors affecting the disease severity can help the clinical management of COVID-19, especially in less privileged areas where fewer resources are available.

Intraocular pressure trend following myopic photorefractive keratectomy.

PURPOSE: To evaluate the intraocular pressure (IOP) trend and risk factors for IOP rise after myopic photorefractive keratectomy (PRK). PATIENTS AND METHODS: One eye of each patient undergone PRK for myopia was randomly assigned to this study. All eyes underwent tonometry by CorVis Scheimpflug Technology (CST) tonometer (Oculus Optikgeräte GmbH, Wetzlar, Germany) 1 week, 2 weeks, 1 month, 2 months, 3 months and 4 months after surgery. The eyes with IOP rise more than 5 mmHg and the risk factors were evaluated by Kaplan-Meier graph and multiple Cox regression analysis. RESULTS: A total of 348 eyes of 348 patients were enrolled in this study. Forty-three eyes (12.35%) experienced a steroid-induced IOP rise of more than 5 mmHg. Eyes with IOP rise had higher baseline IOP (Median 19 mmHg (IQR 18-22) versus Median 15 mmHg (IQR 14-16); p < 0.001). Baseline central corneal thickness (CCT) was higher in eyes without IOP rise (Median 520 µm (IQR 509-541) versus Median 535 µm (IQR 518-547); p = 0.009). In multivariate Cox regression analysis, higher baseline IOP was a risk factor for IOP rise (Hazard Ratio (HR) 1.59 (95% CI 1.43-1.77); p < 0.001) while higher baseline CCT was protective (HR 0.97 (95% CI 0.95-0.98); p < 0.001). CONCLUSION: Eyes with higher baseline IOP and lower baseline CCT are at increased risk of IOP rise after PRK and should be monitored more frequently.

Management of Malignant Glaucoma.

Purpose: To compare the outcomes of various invasive and noninvasive approaches to the treatment of malignant glaucoma. Methods: Glaucoma-related keywords were looked up in PubMed and Google Scholar, and related articles up to 2022 were used to put together this review article. Results: Numerous surgical methods and techniques have been introduced in the past few years. This review outlined current knowledge regarding the nonsurgical and surgical management of malignant glaucoma. In this regard, we first briefly outlined the clinical presentation, pathophysiology, and diagnosis of this disorder. Then, the current evidence on the management of malignant glaucoma was reviewed. Finally, we discuss the need for treatment of the other eye and the factors that might affect the outcome of surgical intervention. Conclusions: Fluid misdirection syndrome, or malignant glaucoma, is a severe disorder that can occur spontaneously due to surgical intervention. The pathophysiology of malignant glaucoma is complicated, and numerous theories exist about the underlying mechanisms that may contribute to the disease. Malignant glaucoma can be treated conservatively using medications, laser therapy, or surgery. Laser treatments and medical treatments have been adequate for the treatment of glaucoma, but the effects have generally been short-lived, and surgical treatment has proved to be the most effective. There have been a variety of surgical methods and techniques introduced. Still, none have been studied in a large proportion of patients as a control case to compare effectiveness, outcomes, and recurrence. Pars plana vitrectomy with irido-zonulo-capsulectomy still seems to have the best results.

The Seroprevalence of COVID-19 in Intravenous Drug Users in Comparison to Non-drug Users.

BACKGROUND COVID-19 infection has led to a worldwide pandemic, and new cases are on the rise. Intravenous drug users (IVDU) are presumably at a higher risk of being infected since they have poor personal hygiene, live in groups, and have risky behaviors. The current study aimed to evaluate the seroprevalence of COVID-19 in IVDU in comparison with non-drug users (N-DU). METHODS This cross-sectional study was conducted on 167 IVDU and 134 N-DU. A questionnaire gathering data on demographics, comorbidities, and use of personal protective equipment was administered to all participants. In addition, 5 cc of blood was taken from each individual to test for SARS-CoV-2 specific antibodies (Pishtaz Teb SARS-Cov-2 ELISA kits). RESULTS The mean age of N-DU and IVDU were 38.9 ± 12.9 and 40.38 ± 10.24 years, respectively. COVID-19 seroprevalence in IVDU was 9.7%, and 4.8% in N-DU, but this finding was not statistically significant (p = 0.096). CONCLUSION While the seroprevalence of COVID-19 was not significantly different among the two groups, IVDU should still be considered by policymakers as a high-risk group due to their lifestyle and risky behaviors. Providing personal protective equipment and other means of protection and treatment to this population can help mitigate the spread of and mortality from COVID-19.

Changes in the morphology of the hyperemic blebs in eyes undergone trabeculectomy with mitomycin C after injection of triamcinolone acetonide during one-year follow-up.

PURPOSE: To track changes in the morphology of hyperemic blebs in eyes undergone trabeculectomy with mitomycin C 0.02% (MMC) after triamcinolone acetonide (TA) injection. METHODS: A total of 30 eyes of 30 patients with localized or diffuse hyperemia after trabeculectomy with MMC were enrolled in this prospective interventional case series. Two milligrams of TA were injected at the site of maximal injection. Bleb morphology was graded using Indiana Bleb Appearance Grading Scale (IBAGS), and the Moorfields Bleb Grading System (MBGS) 1 week, 1 month, 3 months, 6 months, and 1 year after injection. Failure was defined as intraocular pressure (IOP) more than predefined target IOP for each eye, need for an additional surgical procedure, IOP less than 6 mmHg, and loss of Light Perception (LP) vision. RESULTS: A total of 27 patients completed a 1-year follow-up period and were included in the final analysis. The mean time interval from trabeculectomy to injection of TA was 5.98 ± 2.57 weeks. The bleb height and vascularity in the IBAGS system decreased significantly after the intervention (p < 0.05), with an increase in bleb extension (p = 0.006). Using MBGS, the bleb area did not change significantly following TA injection (p = 0.056) but its height and vascularity significantly decreased in both central and peripheral areas and the surrounding conjunctiva (p = 0.032). The development of a mature cataract was the only complication that could be attributed to TA injection. CONCLUSION: Injection of TA in hyperemic failing blebs improves bleb morphology by decreasing vascularity and height while increasing the extent with an acceptable safety profile.

Comparison between sutureless scleral tunnel phacotrabeculectomy with and without placement of anterior capsule remnant.

PURPOSE: To compare sutureless scleral tunnel phacotrabeculectomy with and without placement of anterior capsule remnant in the tunnel. METHODS: In this comparative interventional case series, 41 eyes of 40 patients having open-angle glaucoma (OAG) underwent sutureless scleral tunnel phacotrabeculectomy (Group A) and 28 eyes of 24 patients underwent the same procedure with placement of anterior capsule remnant in the tunnel (Group B). Baseline intraocular pressure (IOP) and IOP at 1 day, 1 month and 6 months after surgery were recorded. IOP < 21 mmHg and 20% reduction in IOP from baseline without and with antiglaucoma medication(s) were considered as complete and qualified success, respectively. Any further procedures or complications that require returning the patient to the operating room or becoming no light perception (NLP) were defined as failure. RESULTS: Mean preoperative IOP was 26.6 ± 10.08 and 26.64 ± 6.31 mmHg in group A and B, respectively (P-value = 0.984). Mean IOP at 1 month was significantly lower in group B (14.24 ± 4.4 versus. 12.07 ± 3.1, P = 0.027) but at 6 months there was no significant difference between groups (14.38 ± 3.56 versus. 14.8 ± 1.85, P = 0.590). The qualified success rate in group B was higher than group A (78.6 versus. 58.5%) at month 1, while the complete success rate was higher in group A than B (34.1% versus. 17.9%). Neither of any group had complete success at month 6. The qualified success rate was 94.7% and 100% in group A and B, respectively, at 6 months. CONCLUSION: Placement of anterior capsule remnant in the ostomy during combined phacotrabeculectomy may improve the outcome of the procedure.

Bilateral spontaneous filtering blebs.

PURPOSE: To report a case of bilateral spontaneous filtering bleb, scleral thinning, microspherophakia, and mild craniofacial dysmorphism. OBSERVATIONS: An 18-year-old girl was referred to our clinic for evaluation of bilateral spontaneous filtering blebs. Her corrected distance visual acuity (CDVA) was 20/400 in the right eye (RE) and 20/100 in the left eye (LE). She had superior scleral thinning, multicystic filtering bleb, and microspherophakia bilaterally. The IOP was 9 mmHg in the RE and 8 mmHg in the LE. A mild craniofacial dysmorphism including downward slanting of palpebral fissures and malar hypoplasia was present. There was no sign of corneal ectasia in tomography. Anterior segment optical coherence tomography revealed the filtering blebs as subconjunctival low reflective fluid-filled spaces. Due to severe scleral thinning un the RE we performed a tectonic scleral patch graft. 6 months after surgery the depth of the anterior chamber increased and CDVA improved. CONCLUSION AND IMPORTANCE: This case indicated that the formation of spontaneous filtering blebs may occur in a syndromic condition. In any case with this symptom, special attention should be paid to craniofacial features, sclera, crystalline lens, and IOP. Tectonic scleral patch graft could be a valuable option in selected patients.

Sequence Analysis of Pvama-1 among Plasmodium Vivax Isolates in Sistan-Baluchistan.

BACKGROUND: Apical Membrane antigen 1 (AMA-1) is an important membrane protein that presents in all Plasmodium species and participates in critical phases in the attraction of cells. In human, it is one of the most immunodominant antigens with a protective immune response simulation role Apical Membrane antigen 1 (AMA-1) is an important membrane protein which presents in all Plasmodium species and is located on the surface of merozoite and sporozoites that participates in critical phases in attraction of human red blood cells by merozoites and hepatocytes by sporozoites, so in human, it is one of the most immunodominant antigens with a protective immune response simulation role. Since extra information is necessary to lighten of AMA-1 scope, we equaled genetic variation in P.vivax AMA-1 from 40 Iranian isolates with those reported from the other malarious countries. METHODS: Blood samples were collected from 40 patients' positive of P.vivax, and genomic DNA was extracted from the blood. The nucleotide sequence for 446 amino acid (AA) residues (42-488 of PvAMA-1) of AMA-1 gene was amplified via PCR and then sequenced. RESULT: A total of 24 different haplotypes were recognized between samples. No new haplotype was determined in this research that was reported previously in other regions of Iran and the world. We detected 37-point mutations at the nucleotide level in their sequences and showed 43 amino acid variations, at 37 positions in which 6 sites demonstrate trimorphic polymorphism, and the others were dimorphic. CONCLUSION: Sequence analysis of the major haplotype showed 95% similarity with P.vivax Sal-1 AMA-1 gene and high level of allelic diversity at the domain I of PvAMA-1 among P. vivax isolates of Iran. Because PvAMA-1 is noticeable as vaccine candidate antigen, these documents provide valuable information for the development of malaria vaccine.

The use of in vivo confocal microscopy to track treatment success in fungal keratitis and to differentiate between Fusarium and Aspergillus keratitis.

PURPOSE: To evaluate the usefulness of serial in vivo confocal microscopy (IVCM) examinations to measure hyphal density for monitoring the treatment success among patients with fungal keratitis, and to compare the hyphal diameter as well as branching angle as a way of differentiation between Aspergillus and Fusarium species observed in IVCM. STUDY DESIGN: Prospective nonrandomized study. PATIENTS AND METHODS: The study was conducted from February 2015 to September 2016. Hyphal diameter, density and branching angle measurements were performed using IVCM at admission and on a weekly basis for at least 2 weeks after the start of treatment. RESULTS: During the period of study, 65 patients with culture-confirmed fungal keratitis were recruited. Of them, 40 were culture-positive for Fusarium spp. and 25 patients for Aspergillus spp. Before the start of treatment, the mean branching angle did not differ between the two species and the mean hyphal diameter was statistically higher for Aspergillus spp. (p = 0.029). Two weeks after the start of treatment, the mean hyphal diameter was statistically lower (p < 0.001) in the treatment failure group. Also the hyphal density significantly decreased with successful treatment (p < 0.05). CONCLUSION: Decreasing hyphal density in serial IVCMs might be used as an indicator to predict the successful response of fungal ulcers to treatment. Branching angle is not different between Aspergillus and Fusarium keratitis. The mean hyphal diameter is significantly lower in the treatment failure group.