Comparison of the effect of three suturing techniques on postkeratoplasty astigmatism in keratoconus.

PURPOSE: To compare the effect of 3 common suturing techniques on postkeratoplasty astigmatism and final best corrected visual acuity (BCVA) in patients with keratoconus. METHODS: In this randomized clinical trial, 103 eyes of 103 patients with advanced keratoconus, who were contact lens intolerant, or with contact lens-corrected visual acuity less than 20/80, underwent penetrating keratoplasty with 3 suturing techniques: interrupted (IR), single running (SR), and combined interrupted and running (CIR). Postkeratoplasty astigmatism and BCVA were evaluated during regular examinations 1.5, 3, 6, and 12 months postoperatively and 2 months after complete suture removal. Suture adjustment and selective suture removal were performed 2 to 6 weeks and after 3 months in eyes with more than 4 D of corneal astigmatism in the SR and IR/CIR groups, respectively. RESULTS: Of 87 patients who completed follow-up, 26 eyes underwent PK with interrupted suturing technique (IR), 26 eyes had single running sutures (SR), and in 35 eyes, the suturing technique was combined (interrupted + running sutures; CIR). Mean age was 27.2 +/- 8.4, 28.9 +/- 8.7, and 30.3 +/- 8.7 years, and postoperative astigmatism 1.5 months after surgery was 3.77 +/- 1.68, 5.48 +/- 2.09, and 4.10 +/- 1.79 D in the 3 groups, respectively (P = 0.015). However, 2 months after complete suture removal, final postoperative astigmatism was 3.83 +/- 1.65, 3.37 +/- 1.9, and 3.88 +/- 2.79 D (P = 0.851) and BCVA (log MAR) was 0.08 +/- 0.14, 0.13 +/- 0.23, and 0.09 +/- 0.16, respectively (P = 0.53). Immunologic endothelial rejection reactions were seen in 5 eyes (19.2%) in the IR group, 3 eyes (11.72%) in the SR group, and 6 eyes (17.64%) in the CIR group (P = 0.44). There was no case of graft failure during the follow-up period. CONCLUSION: Postkeratoplasty astigmatism and BCVA are comparable with the 3 common suturing techniques (IR, SR, and CIR) in patients with keratoconus, provided that regular postoperative examinations and topography-guided suture adjustment and/or removal are performed.

Outcomes of penetrating keratoplasty in keratoconus.

PURPOSE: Keratoconus (KCN) is one of the most common indications of corneal transplantation in Iran. This study was conducted to determine the outcomes of penetrating keratoplasty (PK) for KCN in patients operated in a private practice setting from 1994 to 2001. METHODS: This longitudinal retrospective study included 164 eyes of 164 patients. Variables included preoperative keratometry, trephination and suturing techniques, donor-recipient disparity, surgical complications, immunologic rejection, graft clarity, postoperative spherical and cylindrical refractive error, keratometry, uncorrected and best spectacle-corrected visual acuity, suture management, and the results of keratorefractive procedures. RESULTS: Patients were followed for a mean period of 33.5 months. Mean postoperative best spectacle-corrected visual acuity (BSCVA) at last follow-up was 0.14 +/- 0.11 LogMAR (20/25); mean spherical error and mean corneal astigmatism were -0.61 +/- 2.6 and 3.4 +/- 1.8 D, respectively. Final visual outcomes were not significantly correlated with trephination and suturing techniques or severity of the ectasia. Although donor-recipient disparity did not affect final astigmatism, more myopic shift was observed with greater disparity, but this finding was not of statistical significance. Overall, 26.8% of the patients required keratorefractive surgery, which resulted in 2.9 D reduction in corneal astigmatism. Immunologic graft rejection occurred in 28% of cases; however, all episodes responded to medical management, and none resulted in graft failure. CONCLUSION: Penetrating keratoplasty is a safe and effective procedure with remarkable optical and visual outcomes for patients with keratoconus who are contact lens intolerant or have unacceptable corrected visual acuity. Neither severity of the disorder nor trephination and suturing techniques significantly affects final visual outcomes. Less graft-recipient disparity (0.25 versus 0.50 mm) seems to induce less myopic shift.

Dental Fear and Concomitant Factors in 3-6 Year-old Children.

BACKGROUND AND AIMS: Dental fear/anxiety as a barrier in accessing oral health care is poorly investigated in Iranian children. The aims of this study were to evaluate the prevalence of dental fear and behavior management problems, as well as to examine the relationship between dental fear/anxiety and probable concomitant factors. MATERIALS AND METHODS: Mothers of 200 children aged 3-6 were participated in this descriptive-analytic study, and completed the CFSS-DS, SDQ, Chora and Spielberger questionnaires for both child and parents' general and dental anxiety in this descriptive- analytic study. Behavior was evaluated according to Frankl scale. Statistical approaches included T-test, chi-sq, and Pearson Linear correlation. RESULTS: The mean score of dental fear was 32.15 ± 10 and the prevalence was 22.2%. Significant correlations were found between child's dental fear, general fear and behavior management problems; however, no relationship was found between child's dental fear and parental dental or general fear. CONCLUSION: According to results of this study dental fear/anxiety seems to be more conditional and related to child's temperament than parental impact. Parental evaluation of dental fear can be used as a predictor of child's dental behavior.

Iranian black tea and cowslip extracts induce tumor necrosis factor-alpha secretion from mouse macrophage cell culture.

Many species of tea (Camellia sinensis) and cowslip (Echium amoenum) are used in Iranian traditional medicine. The aim of this study was to conduct the survey on the ability of Iranian black tea and cowslip extracts on secretion of tumor necrosis factor-alpha (TNF-alpha) by non-infected and infected mouse macrophages. A macrophage infection model with Legionella pneumophila and enzyme linked immunosorbent assay (ELISA) technique was used in this study. Research showed that the concentrations of TNF-alpha in non-infected and infected macrophage culture supernatant treated with various concentrations of Iranian black tea and cowslip extracts was significantly higher than the control. Various concentrations of cowslip (0.5, 5 and 50 µg/mL) had significantly a great effect on the induction of TNF-alpha secretion in comparison with the Iranian black tea extract (P < 0.0001). In conclusion, we demonstrated the ability of Iranian black tea and cowslip on the induction of TNF-alpha, which can exert an anti-L. pneumophila activity on macrophages at a low dose. However, further studies to elucidate the mechanism(s) of the induction of macrophages by Iranian black tea and cowslip as well as their potential inhibitory effects on the growth of infected cells and their possible antitumor effects should be carried out in future works.