The effect of implementation of evidence-based eye care protocol for patients in the intensive care units on superficial eye disorders.

BACKGROUND: Superficial eye disorders are one of the most common complications of improper eye care in intensive care units that can lead to corneal ulcers and permanent eye damage. The aim of this study was to determine the effect of the implementation of eye care protocol on the incidence of infection and superficial eye disorders in patients admitted to intensive care units. METHODS: This study was a cross-over clinical trial that was performed on 32 patients admitted to the intensive care unit with reduced or no blink reflex following loss of consciousness or receiving sedatives. The eye of the test group received eye care according to the protocol and the eye of the control group received the routine care of the ward. The data collection form included demographic and clinical information and the clinical score scale of superficial eye disorders, which were completed in 7 days for both eyes. Data analysis was performed by McNemar and Cochran tests with a 95 % confidence interval. RESULTS: In the study of superficial eye disorders, the frequency of dacryorrhea and hyperemia was not significantly different in the second to seventh days in the control and test eyes (P < 0.05). The frequency of xerophthalmia was not significantly different between the control and the test eyes on the second to third days (P < 0.05), but there was a significant difference on the fourth, fifth, sixth, and seventh days (P = 0.0001). Also, the frequency of corneal opacity was not significantly different in the second and third days (P < 0.05), but in the fourth (P < 0.05), fifth, sixth, and seventh days, this difference was significant (P = 0.0001). CONCLUSIONS: Based on the results, although the implementation of eye care protocol has been able to have a significant effect on reducing ocular complications and problems, routine eye care in the intensive care unit also has clinical effectiveness. Therefore, in order to prevent and completely eliminate eye disorders in the intensive care unit, more evidence and research are needed. TRIAL REGISTRATION: The trial was retrospectively registered on https://en.irct.ir/trial/43493 on 13 November 2019 (13.11.2019) with registration number [IRCT20140307016870N5].

An Updated and Comprehensive Meta-Analysis of Association between VEGA -634G > C, -460T > C, +405G > C and +936C > T Polymorphisms and Retinopathy of Prematurity Risk.

BACKGROUND: Previous studies have suggested an association between VEGF-A polymorphisms and retinopathy of prematurity (ROP) risk. But the conclusions are still controversial. The aim of this meta-analysis was to evaluate the association between the VEGF-A polymorphisms and susceptibility of ROP. Methods: We searched PubMed, Scopus, WanFang and CNKI databases for all eligible case-control studies published before September 30, 2019. Results: A total of 27 case-control studies with 5,748 ROP cases and 6,146 controls were selected. The results suggested that there was an association between VEGF-A -460T > C polymorphism and increased risk of ROP under the allele model (C vs. T: OR= 0.879, 95% CI 0.776-0.994, p = 0.040). However, VEGF-A -634G > C, +405G > C and +936C > T polymorphisms were not significantly associated with risk of ROP. The subgroup analysis demonstrated that VEGF-A +405G > C polymorphism was associated with ROP risk in Caucasians. Conclusions: This meta-analysis indicates that VEGF-A -460T > C polymorphism may contribute to the susceptibility for ROP.

Association of MTHFR 677C > T, 1298A > C and MTR 2756A > G Polymorphisms with Susceptibility to Childhood Retinoblastoma: A Systematic Review and Met-Analysis.

BackgroundRecently, epidemiological studies investigating the association of MTHFR 677 C > T, 1298 A > C and MTR 2756 A > G polymorphism with retinoblastoma susceptibility reported controversial results. Methods: Data were collected from several electronic databases such as PubMed, EMBASE, and Google Scholar databases, with the last search up to December 05, 2019. Results: A total of eleven case-control studies including four studies with 324 cases and 490 controls on MTHFR 677 C > T, four studies with 324 cases and 490 controls on MTHFR 1298 A > C, and three studies with 283 cases and 485 controls on MTR 2756 A > G were selected. There was a significant association between MTHFR 677 C > T and MTR 2756 A > G polymorphisms and an increased risk of retinoblastoma. However, MTHFR 1298 A > C polymorphism was not significantly associated with risk of retinoblastoma. Conclusion: This meta-analysis demonstrated that MTHFR 677 C > T and MTR 2756 A > G polymorphisms might play important roles in the development of retinoblastoma. No association with MTHFR 1298 A > C polymorphism was observed.

Association of eNOS and ACE Polymorphisms with Retinopathy of Prematurity: A Systematic Review and Meta-Analysis.

Background: We performed a meta-analysis to clarify the association of endothelial nitric oxide synthase (eNOS) and angiotensin I-converting enzyme (ACE) gene polymorphisms with retinopathy of prematurity (ROP) risk. Methods: PubMed, Medline, and Embase literatures up to June 01, 2019, were reviewed. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the strength of associations. Results: Eighteen case-control studies including 14 studies (810 cases and 1754 controls) on eNOS polymorphisms and four studies (1014 cases and 1215 controls) on ACE I/D polymorphism were selected. Overall, analysis showed that infants with the ACE I/D polymorphism have an increased susceptibility to ROP. No association of eNOS 27-bp, 894 G > T and -786 T > C polymorphisms with ROP risk was found. Conclusion: ACE I/D polymorphism may serve as genetic biomarker of increased ROP risk. The eNOS polymorphisms do not appear to influence susceptibility to ROP.

Clinical characteristics and visual outcomes of animal-induced ocular injuries: a prospective multicenter study in Iran.

Background: Animal-induced ocular injuries represent an under-documented health problem that may pose significant visual complications. This study aimed to investigate the clinical characteristics and outcomes of ocular injuries caused by animals. Methods: This multicenter prospective study enrolled patients with a history of animal-induced ocular injuries presenting to the ophthalmology departments of two tertiary hospitals over a one-year period. All participants underwent comprehensive assessments by ophthalmologists, and the following data were collected: demographic information, animal species involved, injury details, pre- and post-treatment visual data, management strategies, and follow-up outcomes. Results: Seventy-two patients (62.5% male) were included in the study. Insects were the most common species, causing 37.5% of ocular injuries. The type of animal involved was significantly associated with injury patterns (p < 0.0001), visual impairments at presentation (p < 0.05), and need for surgery (p < 0.001). Insects predominantly caused periorbital soft tissue injuries; birds primarily affected the anterior segment; dogs and cats mainly led to adnexal injuries; and equines often involved both anterior and posterior segments. Equine-related injuries resulted in the most severe visual impairments, requiring surgical interventions in all cases. At the same time, the majority of cases involved with other animal species experienced no visual impairment. The number of patients without visual impairment increased from 46 cases (63.9%) at the time of presentation to 58 (80.6%) at discharge after treatment. At follow-up, eight patients (11.1%) experienced complications, including traumatic cataract (n = 6, 8.3%), endophthalmitis (n = 3, 4.2%), corneal scarring (n = 1, 1.4%), and retinal detachment (n = 1, 1.4%). Rooster pecking was the leading cause of complications, including endophthalmitis and traumatic cataract. Conclusion: This study revealed that depending on the type of animal causing the injury, animal-induced ocular injuries present with diverse characteristics, requiring appropriate treatment approaches and potentially resulting in different outcomes. These findings may promote public awareness and improve preventive strategies and clinical guidelines development.

Effects of chloramphenicol, povidone-iodine 1% and 5% eye drops on the colonisation of conjunctival flora in patients undergoing cataract surgery.

Objectives: the aim was to compare 2 drops of either 5% chloramphenicol, 1% povidone-iodine or 5% povidone-iodine before cataract surgery on reducing the colonisation of bacterial flora in the conjunctiva. Design: This was a double-blind, randomised clinical trial study. Setting: Patients referred to Shahid Sadoughi Hospital in Yazd, Iran, for cataract surgery were studied. Participants: Totally 260 patients were enrolled. Intervention: The affected lower fornix was gently sampled with a sterile swab and cultured on appropriate microbiological media. Then one of the 3 solutions mentioned above was instilled into the conjunctival sac of the cases in groups 1, 2 and 3, respectively. After thirty minutes, new conjunctival swabs were taken and cultured. Main outcome measures: The type of bacteria isolated and their colony-forming unit per mL (CFU/mL) number were primary end-points. The statistical tests of Phi and Cramer's V and Wilcoxon and Kruskal-Wallis were applied to evaluate the relationship between the studied variables and culture results as the secondary end-point. Results: The studied patients were 129 (49.6%) males and 131 (50.4%) females. Bacterial growth was observed in 49 cases (18.85%); the most commonly isolated bacteria were Staphylococcus epidermidis (71.42%). In the povidone-iodine 5% and chloramphenicol groups (but not the povidone-iodine 1%), the decrease in the number of CFU/mL was statistically significant (P = 0.032 and P = 0.005, respectively, Wilcoxon test). Conclusion: A single dose of povidone-iodine 5% and chloramphenicol effectively reduces the colonisation of normal conjunctival bacteria and can be used as effective prophylaxis. Funding: This study was part of an MSc thesis of Nasrin Tofighi. Shahid Sadoughi University of Medical Sciences, Yazd, Iran, funded this work.

Effect of Training Eye Care Clinical Guideline for ICU Patients on Clinical Competence of Eye Care in Nurses.

INTRODUCTION: Sight is one of the most important and vital human senses. Lack of proper eye care (EC) in anesthetized patients can lead to serious ocular complications and even vision loss. Insufficient knowledge, attitude, and skills of nurses are considered as a barrier to providing EC in the intensive care unit (ICU). The aim of the present study was to determine the effect of training EC clinical practice guidelines for ICU patients on nurses' knowledge, attitude, and practice of EC. METHODS: This was an interventional study with a pre-post design performed on 60 ICU nurses. For the experimental group, EC clinical guideline training was performed for anesthetized patients in three sessions. The data collection tool included nurses' clinical competence of the EC questionnaire with a possible score range of 0-86. This tool consists of three domains, including knowledge (0-18), attitude (0-28), and practice (0-40), which was completed in a self-assessment manner before and three months after the training program. Data analysis was carried out using SPSS16. Findings. The mean scores of knowledge, attitude, and practice after the intervention in the experimental and control groups were 15.03 ± 2.72 and 11.11 ± 3.50, 25.65 ± 3.47 and 22.07 ± 3.08, and 33.88 ± 4.14 and 28.5 ± 55.08, respectively, which were statistically significant (P ≤ 0.001). Also, the total score of clinical competence of EC after the intervention in the experimental and control groups was 74.56 ± 7.93 and 61.74 ± 9.66, which showed a significant difference (P ≤ 0.001). CONCLUSION: Training nurses based on EC clinical guidelines for anesthetized patients can improve the knowledge, attitude, and practice of ICU nurses. Evidence-based EC practice requires continuous training based on clinical guidelines and EC practice monitoring by nursing managers according to EC clinical guideline for an anesthetized patient.

Association of MTHFR C677T and A1298C Polymorphisms with Glaucoma Risk: a Systematic Review Meta-Analysis based 42 Case-Control Studies.

Aim: Several epidemiological studies have been performed to explore the association of MTHFR polymorphisms with glaucoma risk. However, the results were inconsistent or even inconclusive. Hence, we performed a meta-analysis to evaluate the association of MTHFR C677T and A1298C polymorphisms with glaucoma risk. Methods: A comprehensive literature search on PubMed, Google Scholar, EMBASE, and CNKI databases was performed to find all eligible studies up to January 30, 2019. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of such association. Results: A total of 42 case-control studies including 33 studies for MTHFR C677T and nine studies for A1298C polymorphism were selected. Pooled results showed that there was no significant association between the MTHFR C677T polymorphism and glaucoma risk. Similarly, no associations were found in subgroup analysis based on ethnicity and glaucoma type. However, there was a significant association between the A1298C polymorphism and the increased risk of glaucoma under heterozygote model (OR=0.765, 95% CI=0.626-0.935, P=0.009). Moreover, the significant association between MTHFR A1298C polymorphism and glaucoma were found by ethnicity and primary open angle glaucoma (POAG). Conclusions: The present meta-analysis revealed that MTHFR A1298C polymorphism is significantly associated with the increased risk of glaucoma, but not MTHFR C677T polymorphism.

Association of MTHFR 677C>T, 1298A>C and MTR 2756A>G Polymorphisms with Risk of Retinoblastoma.

BACKGROUND: The MTHFR 677C>T, 1298A>C and MTR 2756A>G polymorphisms have been investigated in several different cancer types. However, the role of these polymorphisms in the development of retinoblastoma remains unclear. Here, we have evaluated the association of the MTHFR 677C>T, 1298A>C and MTR 2756A>G polymorphisms with the risk of retinoblastoma in Iranian children. METHODS: The MTHFR 677C>T, 1298A>C and MTR 2756A>G polymorphisms in 66 patients with retinoblastoma and 99 age-and gender-matched healthy controls were detected on the ABI PRISMs 7500 Real-Time PCR System. The association between these polymorphisms and the risk of retinoblastoma was analysed by an odds ratio with a 95% confidence interval. RESULTS: Our results showed a significant association between the MTR 2756A>G polymorphism and the risk of retinoblastoma. In the MTR 2756A>G polymorphism, the AG (39.4%) and GG (9.1%) genotype frequencies in the cases were found to be higher in comparison with the controls, showing a significant difference (p < 0.05). However, no significant difference was observed in the allelic or genotypic frequencies for both the MTHFR 677C>T and 1298A>C polymorphisms in the retinoblastoma patients of the controls (p > 0.05). CONCLUSIONS: Our results suggested that the MTR 2756A>G polymorphism might be associated with an increased risk of retinoblastoma in Iranian children. However, the results show that the MTHFR 677C>T and 1298A>C polymorphisms are not significantly associated with an increased risk of retinoblastoma.

Association between the p53 codon 72 polymorphism and primary open-angle glaucoma risk: Meta-analysis based on 11 case-control studies.

The TP53 is important in functions of cell cycle control, apoptosis, and maintenance of DNA integrity. Studies on the association between p53 codon 72 polymorphism and primary open-angle glaucoma (POAG) risk have yielded conflicting results. Published literature from PubMed and Web of Science databases was retrieved. All studies evaluating the association between p53 codon 72 polymorphisms and POAG were included. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated. Eleven separate studies including 2541 cases and 1844 controls were pooled in the meta-analysis. We did not detect a significant association between POAG risk and p53 codon 72 polymorphism overall population except allele genetic model (C vs. G: OR = 0.961, 95% CI = 0.961-0.820, P = 0.622). In the stratified analysis for Asians and Caucasians, there was an association between p53 codon 72 polymorphism and POAG. In the dominant model in the overall population and by ethnicity subgroups, the highest elevated POAG risk was presented. In summary, these results indicate that p53 codon 72 polymorphism is likely an important genetic factor contributing to susceptibility of POAG. However, more case-controls studies based on larger sample size and stratified by ethnicity are suggested to further clarify the relationship between p53 codon 72 polymorphism and POAG.

Single cotton wool spot as a late manifestation of head trauma.

PURPOSE: To report a patient with a single cotton wool spot (CWS) following head trauma. CASE REPORT: A 37-year-old male electrician presented with painless paracentral blurred vision in his left eye of one month duration together with three transient episodes of obscuration of vision in the same eye lasting for 10 minutes. He reported blunt head trauma due to a fall 40 days before referral. Fundus examination at presentation was normal but after 4 months, revealed the appearance of a white spot along the superotemporal arcade in the absence of other fundus lesions. A comprehensive systemic workup was performed revealing no specific findings. Ophthalmoscopic examination after 6 weeks disclosed resolution of the CWS with no intervention. The patient's complaint of paracentral visual field defect improved and subsequent optical coherence tomography showed retinal thinning in that area. CONCLUSION: Herein, we report a patient with a single CWS near the optic disc four months after head trauma along with normal systemic and paraclinical evaluations. Head trauma may thus be considered as a cause of CWS.

Efficacy of topical bevacizumab for inhibiting growth of impending recurrent pterygium.

PURPOSE: To evaluate clinical outcome(s) and complication(s) of topical bevacizumab (avastin) in patients with impending recurrent pterygium. PATIENTS AND METHODS: This prospective clinical trial included 54 consecutive patients (54 eyes), who underwent pterygium surgery with bare sclera and mitomycin, and who were diagnosed with impending recurrent pterygium. Of the 54 patients, 26 received eye drops containing bevacizumab (5 mg/ml) twice a day and betamethasone four times daily for 1 week. In the other 28 patients, betamethasone alone was administered four times daily for 1 week. Follow-up times were 3-6 mos. RESULTS: All patients in both groups failed, i.e., fibrovascular tissue (pterygia) eventually extended onto the cornea. However, in patients receiving topical bevacizumab, the mean progression of fibrovascular tissue extension during the first week, first month, and third month of follow-up was significantly less than that in the control group (p < 0.01). The mean duration for invasion of cornea in study group patients was significantly longer than that for control group patients (p < 0.01). CONCLUSION: Short-term use of topical bevacizumab seems to be a safe and effective means for delaying recurrence of impending recurrent pterygia.