Comparative analysis of two different types of intracorneal implants in keratoconus: A corneal tomographic study.

OBJECTIVE: To evaluate changes in visual acuity and corneal tomographic outcomes at 6 months after femtosecond-laser assisted implantation of two different types of intracorneal implants in keratoconus. METHODS: A total of 39 keratoconus eyes implanted with two segments KeraRing (n = 22 eyes) or MyoRing (n = 17 eyes) were enrolled. Tomographic data (Pentacam system, Oculus) were analyzed and correlated with enhancement in uncorrected (UDVA) and corrected distance visual acuity (CDVA). The tomographic indices were front maximum keratometry (Kmax), corneal asphericity (Q-value) on both surfaces, average pachymetric progression indices (PPI), maximum Ambrosio relational thickness (ARTmax), Belin-Ambrósio enhanced ectasia total deviation index (BAD-D), index of surface variance (ISV), vertical asymmetry (IVA), height asymmetry (IHA) and height decentration (IHD). RESULTS: LogMAR UDVA and CDVA improved 2.1 (p = 0.003) and 0.7 (p = 0.074) lines with KeraRing, and 8 and 2.5 lines with MyoRing (p = 0.001). The highest and lowest mean differences in the tomographic indices between both groups were related to ISV and IHD, respectively. Changes in all indices differed significantly between two groups except for changes in front corneal astigmatism, ARTmax, ISV, IVA, IHD and IHA (p > 0.05). Correlation of changes in CDVA with changes in other parameters was statistically significant only for IHD in the KeraRing group, while changes in in UDVA were significantly correlated with changes in spherical equivalent, back Q-value, ISV, IVA, and IHA only in the MyoRing group. CONCLUSION: Both implants promote corneal shape regularization and an enhancement in UDVA in keratoconus. A considerable flattening effect and reduction in prolateness in the front corneal surface were observed with MyoRing.

Corneal biomechanical parameters in keratoconus eyes with abnormal elevation on the back corneal surface only versus both back and front surfaces.

Corneal biomechanical parameters were compared in 100 keratoconus eyes with abnormal elevation on the back corneal surface only (group 1), versus both the back and front surfaces (group 2). Scheimpflug tomography with Pentacam HR, corneal biomechanical assessments using Corvis ST and Ocular Response Analyzer (ORA) and corneal epithelium thickness maps using anterior segment optical coherence tomography were assessed. There were no significant differences in the IOP measured using Corvis ST and ORA, age or sex between the two groups. Statistically significant differences were found in all corneal shape parameters and all new parameters of Corvis ST: corneal stiffness parameter at first applanation (SP-A1), integrated inverse radius (IR) and deformation amplitude ratio (DAR)) between groups (p < 0.001). The classic parameters of ORA including corneal hysteresis (CH) and corneal resistance factor (CRF) were about 1.00 mmHg higher in group 1 (p < 0.001). In conclusion, keratoconus eyes with abnormal elevation limited to the back corneal surface have lower grade, stiffer corneal biomechanical parameters and less asymmetric shape. This is consistent with progressive biomechanical weakening from the first detectable back surface elevation to manifestation on the front surface as the severity overwhelms the ability of the epithelium to compensate.

Corneal Epithelial Thickness Mapping After Photorefractive Keratectomy for Myopia.

PURPOSE: To evaluate the longitudinal changes in epithelial thickness after photorefractive keratectomy (PRK) and correlate these with refractive changes. METHODS: This prospective study included 52 eyes of 52 candidates for myopic PRK. Along with standard ophthalmic examinations, corneal epithelial thickness mapping by anterior segment optical coherence tomography was performed. Epithelial thickness maps of 9-mm diameter were divided into 25 sectors, including a central 2-mm zone and eight octants within para-central (2 to 5 mm), midperipheral (5 to 7 mm), and peripheral (7 to 9 mm) annular zones. All PRK treatments were performed using the Technolas Teneo 317 model 2 excimer laser (Bausch & Lomb, Rochester, NY) and an aspheric profile with a 6-mm diameter optical zone. Follow-up was at 1, 3, and 6 months. RESULTS: Repeated thickness measures before and after PRK at different follow-up times showed a significant difference in thickness separately in various zones (P < .001). A significant decrease in thickness was seen 1 month after PRK in all zones. Afterward, epithelial thickening continued in all zones and reached the preoperative thickness in the midperipheral and peripheral zones 6 months later, whereas the thickness in the central 5-mm zone was significantly thicker than before surgery. There was also a significant correlation between changes in spherical equivalent and epithelial thickness from before to 6 months postoperatively in the paracentral and peripheral zones. CONCLUSIONS: There was a marked decrease in the epithelial thickening pattern at 1 month after PRK, with gradual thickening at 3 and 6 months. Changes in epithelial thickness and spherical equivalent were significant only for the para-central peripheral zone. [J Refract Surg. 2019;35(10):632-641.].

Impact of clinical factors on calorie and protein intakes during Icu stay in adults trauma patients: results from a prospective observational study.

Propose: Nutritional requirements are often escalated following major trauma. Underfeeding and adverse outcomes were seen in critically ill trauma patients. The aim of the study was to quantify actual amount of calories and protein intakes, and extent to which those clinical factors may affect adequate intake. MATERIAL AND METHODS: An observational study carried out in a medical intensive care unit (ICU) of Tabriz University of medical science during April 2017 and December 2018. A total of 85 adult trauma patients with a 7 days ICU length of stay and who received Enteral nutrition (EN) were included in this study. The data on estimated and actual intake of energy and protein, severity of illness (i.e., Acute Physiology and Chronic Health Evaluation II (APACHE II), The Glasgow Coma Scale (GCS) and markers of nutritional status (i.e., serum albumin level and body mass index) were recorded. RESULTS: In this study, sixty-six patients (77%) were underfed in terms of energy and 19 patients (23%) had adequate energy intake. Logistic regression showed that only GCS possibly predict energy status. For every one-unit additional decrease in GCS scores, the odds of being underfed in terms of energy were increased by 1.32 times, after controlling for other factors (95% CI, 1.07 to 1.75, P-value = 0.044). No association was observed between nutritional status and clinical outcomes. CONCLUSIONS: The definite nutritional intake did not coverage the calculated requirements during ICU stay. The current study proposed that there was an inverse association between some clinically important factors (APACHE II score, intubation time) and mean energy intake. Nutritional support was not associated with any complications.

Effects of Topical 1% Sodium Hyaluronate and Hydroxypropyl Methylcellulose in Treatment of Corneal Epithelial Defects.

We aimed to compare the therapeutic effects of topical 1% sodium hyaluronate (Healon) or hydroxypropyl methylcellulose (HPMC) for the treatment of alkali-induced epithelial corneal defects. An alkali burn was produced in 30 corneas of 30 New Zealand White rabbits, using a 7.5-mm-diameter trephine. The rabbits were randomly divided into three groups. Four times a day, one group was treated with 1% sodium hyaluronate, one with HPMC, and one (the control group) with physiologic saline. During the treatment period, the size of the epithelial defect was observed every day, up to day 17, using a slit-lamp biomicroscope (with fluorescein). Sodium hyaluronate significantly accelerated the wound healing process compared with saline and increased the healing rate to an even greater extent compared with HPMC. Sodium hyaluronate, but not HPMC, is an effective wound-healing adjuvant for alkali-induced corneal epithelial defects.

Beneficial role of antioxidants on clinical outcomes and erythrocyte antioxidant parameters in rheumatoid arthritis patients.

BACKGROUND: This study aims to investigate the effect of antioxidants supplement on clinical outcomes and antioxidant parameters in rheumatoid arthritis (RA). METHODS: The pre-post study was conducted on 40 female patients with RA in 12 weeks that taken daily one Selenplus capsule contained 50 µg selenium, 8 mg zinc, 400 µg vitamin A, 125 mg vitamin C, and 40 mg vitamin E. About 5 mL venous blood sample was taken from all participants and disease activity score (DAS) was determined by DAS-28 formula and high-sensitive C-reactive protein (hs-CRP). Glutathione peroxidase (GPX) and superoxide dismutase (SOD) were measured by spectrophotometric kit and catalase (CAT) was measured by Abei method. Total antioxidant capacity (TAC) was determined by spectrophotometric kit. Distribution of the variables was assessed using histogram with normal curve as well as Kolmogorov-Smirnov test and data were analyzed with paired t-test for differences between pre-post data using SPSS software version 13.5. CONCLUSIONS: Our findings showed that antioxidants may improve disease activity significantly, but it did not affect the number of painful and swollen joints and increased erythrocyte antioxidant levels. Antioxidants may be useful for controlling of clinical outcomes and oxidative stress in RA.