Long-term comparison of the outcomes of Ahmed Glaucoma Valve surgery between glaucoma surgeons and cornea trained surgeons.

PURPOSE: To compare the long-term outcomes obtained by glaucoma surgeons versus cornea trained surgeons performing Ahmed glaucoma valve (AGV) surgery. METHODS: Of the total 376 patients (3 month to 83 year) conducted in this retrospective study, 130 patients with refractory glaucoma were evaluated who had been followed up for at least six months during ten years period. The primary outcome measure was the surgical success of AGV surgery that was categorized in two groups: (A5 ≤ IOP ≤ 21 mmHg and at least 20% reduction in IOP without any glaucoma medications (complete success) and reduction by using one or more glaucoma medications (qualified success) (B) similar to previous criteria but the cutoff for higher IOP at 16 mmHg without vision loss and the need for medication or re-surgery. RESULTS: Mean age of the patients was 32.99 ± 24.20 years in the glaucoma surgeon group and 25.18 ± 24.33 years in the cornea trained surgeons group (P = 0.07). The overall success of both methods at the end of four years were 66.7% and 41.7% for the group of glaucoma surgeons and cornea trained surgeons, respectively (p = 0.661). The cumulative success according to criterion A and B was 66.7% in the glaucoma surgeon group and 47.1% in the others surgeon group (P = 0.661). Repeated glaucoma surgery was required in 33.3% and 52.9% of the patients in the glaucoma surgeon and cornea trained surgeons groups, respectively (P = 0.661). Although there was a significant difference for IOP among various follow-up periods (p = 0.004), this difference was not significant between the two groups (p = 0.374).Visual Acuity did not have a signifiant difference between various follow-up periods and surgeons groups (p = 0.419 and P = 0. 690, respectively). CONCLUSION: There were comparable outcomes with regard to complications and success rates between glaucoma surgeons and cornea trained surgeons performing AGV surgery.

Comparison of the effect of removing bandage contact lens on the days 3 and 5 following photorefractive keratectomy.

AIM: To compare the outcomes of removing bandage contact lens (BCL) on days 3 and 5 after photorefractive keratectomy (PRK). METHODS: One hundred patients who underwent PRK (a total of 200 eyes) were enrolled in the present study. The subjects were assigned to two groups. Group 1 consisted of the right eyes of subjects and bandage contact lenses removal were on the 3rd day; Group 2 consisted of the fellow eyes of same subjects and removed bandage contact lenses on the 5th day after PRK. Then, data obtained from both groups were compared. To evaluate complications, the subjects underwent a slit-lamp examination in all visits. RESULTS: Filamentary keratitis was observed in one eye in both groups. The frequency of haze was higher in group 1; however, it was not significant between the two groups. Using mixed model analysis, significant differences were observed in the rate of complications as well as pain and eye discomfort scores between the groups (P < 0.05). No major complication was reported. CONCLUSION: Majority of post-PRK corneal epithelial defect is healed on day 3. However, keeping BCL for 5 days postoperatively instead of the three days produces a slightly lower rate of total complication.

Use of low-vault posterior chamber collagen copolymer phakic intraocular lenses for the correction of myopia: a 3-year follow-up.

BACKGROUND: Phakic intraocular lens (pIOL) models have indicated an association between cataract formation and inadequate vaulting. In this study, the efficacy and safety of low-vault posterior chamber pIOLs in the correction of myopia were examined over 3 years. METHODS: From 316 patients undergoing surgery, 14 eyes with a low vault (≤ 150 µm) were examined from 14 patients. After implanting the Visian Implantable Collamer pIOL for the correction of myopia (moderate and high), the pIOL vault, endothelial cell loss, uncorrected distance visual acuity (UDVA), corrected DVA (CDVA), and detrimental events were examined over 3 years. RESULTS: Based on the findings, the mean spherical equivalent reduced from - 8.15 ± 3.29 before surgery to - 1.02 ± 0.75 diopters 3 years after the surgery. In terms of visual outcomes, the mean UDVA (Log MAR) significantly increased from 0.95 ± 037 to 0.27 ± 0.28, and the mean CDVA also increased from 0.99 ± 0.11 to 0.06 ± 0.08 (P < 0.05). The mean indices of safety and efficacy were respectively 1.075 and 0.748. The eyes lost not more than two visual acuity lines. Based on the findings, 82% achieved 0.80 or better CDVA, while the total endothelial cell loss was 7.96% during 3 years. Overall, vision-threatening conditions were not reported. CONCLUSION: The introduced pIOL can be considered a safe and efficient method for myopia at moderate to high levels.

Comparison of the MyoRing implantation depth by mechanical dissection using PocketMaker microkeratome versus Melles hook via AS-OCT.

BACKGROUND: This paper seeks to evaluate the depth and outcomes of MyoRing implantation using two mechanical dissection procedures including: PocketMaker microkeratome in opposition to the Melles hook method. METHODS: This retrospective study was carried out on 39 eyes of 38 keratoconus patients (28 male and 10 female) with the mean age of [Formula: see text] years and had undergone MyoRing implantation by the two mentioned methods. The MyoRing was inserted into the corneal pocket which was made manually in 18 eyes (Melles hook group) or with PocketMaker microkeratome in 21 eyes (PocketMaker group). The mean follow up time was [Formula: see text] months with pre-operative and post-operative ophthalmic examination including uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), keratometry readings and central corneal thickness measurement. AS-OCT (Casia, SS-1000, Tomey, Nagoya, Japan) imaging was used to measure MyoRing insertion depth, exactly. RESULTS: Pre-operative and post-operative UCVA (LogMAR) mean change for the PocketMaker and Melles hook groups were recorded at 0.75 ± 0.32 and 0.78 ± 0.33, respectively. Similarly, BCVA (LogMAR) mean change were 0.27 ± 0.22 and 0.23 ± 0.22. Mean keratometry (Kmean) change were 6.06 ± 4.18 and 6.56 ± 3.55 respectively. UCVA change (P = 0.767), BCVA change (P = 0.77) and Kmean change (P = 0.693) showed that there was no statistically significant difference between both groups for any parameter. Depth measurements achieved from AS-OCT images showed that there was no statistically significant difference in pocket depth between two methods of MyoRing implantation (P = 0.413). CONCLUSIONS: The results of Myoring implantation outcomes using mechanical dissection via PocketMaker microkeratome as against Melles hook are comparable.

Effects of intravitreal injection of bevacizumab with or without anterior chamber paracentesis on intraocular pressure and peripapillary retinal nerve fiber layer thickness: a prospective study.

PURPOSE: To investigate the effects of intravitreal injection of bevacizumab (IVB) with or without anterior chamber paracentesis on intraocular pressure (IOP) and peripapillary retinal nerve fiber layer (PRNFL) thickness. METHODS: In this prospective randomized clinical trial, 90 eyes with center involving diabetic macular edema or wet type age-related macular degeneration (AMD) were randomly assigned to receive IVB either without (group A) or with (group B) anterior chamber paracentesis. IOP was measured before and within 2 min, 30 min, 24 hours and 3 months after injections. Peripapillary spectral-domain optical coherence tomography (SD-OCT) was performed before and 3 months after injections. RESULTS: Mean IOP changes 2 minutes, 30 minutes, 24 hours, and 3 months after injections were 26.4 ± 5.7 mmHg (P < 0.001), 6.5 ± 6.3 mmHg (P < 0.001), 0.2 ± 2.9 mmHg (P > 0.99) and 0.5 ± 2.4 mmHg (P > 0.99) in group A and -1.3 ± 2.4 mmHg (P < 0.001), -3.2 ± 1.8 mmHg (P < 0.001), -3.1 ± 1.8 mmHg (P < 0.001) and -1.8 ± 2.2 mmHg (P < 0.001) in group B, respectively Mean baseline average PRNFL thickness was 85.3±5.6 µm and 85.6 ± 5 µm in groups A and B respectively. Mean PRNFL thickness changes after 3 month was -2 ± 2 µm (P < 0.001) in group A and 0 ± 2 µm (P = 0.101) in group B. Mean PRNFL thickness in group A decreased more than group B (P < 0.001). CONCLUSION: Conventional method of IVB injection was associated with acute IOP rise and significant PRNFL loss 3 months after injection. Anterior chamber paracentesis prevents acute IOP rise and PRNFL loss.

Cytomegalovirus keratitis in acute myeloblastic leukemia.

A 58-year-old woman presented with acute myeloblastic leukemia (AML) developed a bilateral dendritic epithelial keratitis without retinitis. The patient was initially treated with oral acyclovir with a possible diagnosis of herpes simplex virus (HSV) keratitis. Polymerase chain reaction (PCR) was performed on ocular discharge specimens collected by soft-tipped applicators reported as cytomegalovirus (CMV). Then, acyclovir was discontinued and bilateral CMV keratitis was treated with IV ganciclovir and her epithelial lesions gradually disappeared. The current case report confirms that CMV is capable of generating corneal epithelial engagement without retina involvement and demonstrated that CMV keratitis is an emergent problem of AML. Therefore, in any case with bilateral corneal herpes keratitis, the patient should be evaluated for immune system deficiency.

Innovative intra-corneal ring-supported graft surgery for treatment of keratoconus and cornea regeneration: Surgical technique and case report.

Therapeutic options for corneal ectasia are evolving, with emphasis on the intra-stromal corneal ring for delaying or eliminating the need for penetrating keratoplasty. A 33-year-old man with grade 4 keratoconus and rising intolerance of the hard contact lens underwent a combination of a new innovative ring and graft with suture in the left eye. Excellent structural support and stability of the cornea were observed immediately post-operatively and 12 months after surgery. It appears as a feasible and safe therapy option for keratoconus eyes with reference to the instability and asymmetry of the cornea. Hence, as a safe and effective technique, it can be performed easily.

Long-term results of MyoRing implantation in patients with keratoconus.

Clinical relevance: This study was conducted to evaluate five-year outcomes of MyoRing implantation in patients with keratoconus. The results showed that MyoRing implantation is a minimally invasive procedure and is safe and effective for improving visual acuity and refraction in most patients with keratoconus.Background: The long-term effects of MyoRing implantation on corneal features were studied.Methods: A total of 48 keratoconic eyes of 43 consecutive patients who had undergone MyoRing implantation using the Pocket Maker microkeratome (Dioptex, gmbh, Linz, Austria) and who had completed five years of follow­ups were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and keratometry (K) readings were measured and assessed pre-operation, and five years post-operatively. As well, post-operation satisfaction was assessed using a validated questionnaire.Results: Five years post-operatively, there was a significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder (p < 0.001). Mean UDVA was 1.20 logMAR before the surgery and 0.42 after the surgery (p < 0.001). Mean CDVA was 0.63 logMAR before the surgery and 0.20 logMAR after the surgery (p < 0.001). SE was improved from -6.53 dioptres (D) before the surgery to -2.23 D after the surgery (p < 0.001). Moreover, the results show that the mean K was reduced by 2.82 D after the surgery (p = 0.001). Overall, 81% of patients were moderately to highly satisfied five years after surgery.Conclusion: MyoRing implantation was found to be a minimally invasive procedure, and is safe and effective for improving visual acuity and refraction in most patients with keratoconus.

Ascorbic acid versus placebo in postoperative lid edema postphotorefractive keratectomy: A double-masked, randomized, prospective study.

INTRODUCTION: Photorefractive keratectomy (PRK) is a proper type of refractive surgery used to remodel corneal stroma to compensate refractive errors. Corneal haze was reported as one of the side effects in several studies. This study was conducted for investigation of the effect of preventive effect of Vitamin C on eyelid edema, corneal haze, corneal epithelial healing, mitigation of pain, and epiphora. MATERIALS AND METHODS: This study has been performed as a double-blind clinical trial on 51 patients who underwent PRK surgery. The patients were randomly divided into two groups as follows: case group who received oral ascorbic acid 250 mg once daily for 7 days and control group that took placebo 3 days before and 4 days after the surgical operation. The patients underwent a surgical operation on day 0. Then, the following factors were evaluated as the main outcome: postoperative lid edema, pain, corneal haze, and corneal reepithelialization. RESULTS: The mean age of the patients was 28.52 ± 8.05 years. There was no statistically significant difference in the primary outcome of the subjective pain scores along with corneal haze and corneal reepithelialization between the treatment and placebo groups at any point during the postoperative period; however, there was a statistically significant difference and trend for lower lid edema in the ascorbic acids group on postoperative day 1 (P < 0.05). CONCLUSION: This study demonstrates that ascorbic acid may provide an alternative or add-on option for lid edema relief after PRK.

Intravitreal bevacizumab administration for the treatment of chronic central serous chorioretinopathy.

PURPOSE: To evaluate the effects of intravitreal bevacizumab (IVB) injection on chronic central serous chorioretinopathy (CSC). METHODS: In this prospective interventional case series, a total of 22 eyes of 22 patients, diagnosed with unresolved CSC for three months or longer, received 1.25 mg IVB injection. Also, in case of failure to achieve success parameters, double dose IVB injections continued in order to reach the complete subretinal fluid (SRF) absorption. A complete ophthalmic assessment was carried out one day, one week, and one-month post-injection, and then a monthly visit was performed, and re-injection was done if needed. Visual acuity, subretinal space volume (SSV), central macular thickness (CMT), and contrast sensitivity were measured and compared among baseline values and final post-treatment values. RESULTS: The mean best corrected visual acuity increased significantly from 0.70 ± 0.22 to 0.17 ± 0.15 logMAR (P <0.001), and the CMT showed a significant reduction from 557.36 ± 129.12 to 259.50 ± 116.73 µm (P <0.001 ). In addition, SSV decreased significantly from 10.53 ± 2.03 to 6.63 ± 1.80 (P = 0.001), and contrast sensitivity improved significantly from 13.8182 ± 2.64820 dB to 17.6818 ± 1.80967 dB (P <0.001). CONCLUSION: In this series, SRF absorption occurred and visual acuity improved after IVB injections, however, further comparative studies are needed to show the effect of IVB in chronic CSC.

Which quadrant is less painful for intravitreal injection? A prospective study.

PURPOSE: To evaluate the relationship between injection site and pain severity following intravitreal injection of bevacizumab (IVB). DESIGN: Prospective, randomized, four-armed, clinical trial. METHODS: The present study was a prospective, randomized, four-armed clinical trial, which included 1004 eyes from 1004 patients. Patients receiving IVB were randomly assigned into four groups: superotemporal (ST); superonasal (SN); inferotemporal (IT); and inferonasal (IN) injections. The visual analog scale (VAS) was used to assess pain. Primary study variables were the relationship between pain severity and injection site, number of previous injections, age, sex, and indication for injection. Secondary variables included best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes 1 month post IVB. RESULTS: Overall mean pain score was 2.86 ± 2.2. Indications for injection were diabetic macular edema (84.1%), neovascular age-related macular degeneration (7.7%), and macular edema secondary to retinal vein occlusion (8.2%). The mean VAS scores in the SN, IN, ST, and IT groups were 1.5 ± 1.7, 3 ± 2.3, 4 ± 2, and 3 ± 2.1, respectively. Pain severity was significantly correlated with injection site (p < 0.001) and sex (p < 0.001); females showed higher pain scores. A negative correlation existed between pain score and number of previous injections (p = 0.03). Pain severity was not associated with age (p = 0.659), lens status (p = 0.478), vitreous reflux (p = 0.648), or indication for injection (p = 0.390). No significant complications were observed. CONCLUSIONS: ST quadrant was the most painful and SN quadrant was the least painful sites for IVB. Pain severity score was significantly associated with injection site, number of injections, and sex.

Pre-operative factors influencing post-operative outcomes from MyoRing implantation in keratoconus.

BACKGROUND: To identify pre-operative factors that influence post-operative performance of a full-ring intra-corneal implant (MyoRing) for the management of keratoconus. METHOD: In a retrospective study, medical records of 70 keratoconus eyes of 70 consecutive surgical patients with a mean age of 28.54 ± 6.52 years, who underwent MyoRing implantation using the PocketMaker microkeratome (Dioptex GmbH), were included and analysed before implantation and for visual outcome. Variables assessed included age, gender, keratoconus shape, uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent and keratometry reading. After the last follow-up, the eyes were graded for MyoRing implantation performance into worst, moderate and best subgroups. RESULTS: The mean values of uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent, manifest sphere and cylinder improved significantly post-operatively (p < 0.05). A statistically significant difference was found in the mean spherical equivalent (p = 0.046) and uncorrected distance visual acuity (p = 0.001) between moderate and best subgroups. No statistically significant correlation was found between age, sex, keratoconus shape, keratometric values, corrected distance visual acuity and visual outcome. CONCLUSIONS: According to this new grading system for MyoRing implantation performance, pre-operative uncorrected distance visual acuity and spherical equivalent are considered as the most important indicators for surgical performance in MyoRing treatment of keratoconus.

Keratoconus treatment using femtosecond-assisted intrastromal corneal graft (FAISCG) surgery: a case series.

We describe an intrastromal corneal graft technique that uses femtosecond laser to create a desirable corneal lenticule with precise diameter, depth, and shape as well as an intra-stromal pocket in keratoconus patients. The technique seems to be a feasible and safe treatment option to treat keratoconic eyes with reference to the irregularity and instability of cornea. The technique can be performed easily and appears safe and effective. At 7 days postoperatively, all eyes were white and quiet, and the grafts were clear. No graft folds or interface complications were observed at the 12-month follow-up using Visante optical coherence tomography.

Evaluation of choroidal thickness and retinal nerve fiber layer thickness in patients with unilateral amblyopia: a prospective study / Avaliação da espessura da coroide e da camada de fibras nervosas da retina em pacientes com ambliopia unilateral: um estudo prospectivo

ABSTRACT Purpose: to compare the Subfoveal choroidal thickness (SFCT) and Retinal Nerve Fiber Layer Thickness (RNFL) of amblyopic and normal fellow eyes. Design: Prospective, cross-sectional, observational case series. Methods: Forty patients age 12 to 41 years (mean 23.73 ± 6.42) with unilateral amblyopia were studied. Among them, 11(28.2%) patients had amblyopia secondary to strabismus and 29(71.8 %) had anisometropic amblyopia. Optical coherence tomography (OCT) of the peripapillary RNFL thickness of amblyopic and fellow eyes was performed. RNFL thickness measurements were taken from the superior, inferior, nasal and temporal quadrants in the peripapillary region. Also, subfoveal choroidal thickness (SFCT) was measured using spectral domain optical coherence tomography (SD-OCT). Results: Mean global RNFL thickness of the amblyopic and fellow eyes was 104.48 microns and 102.83 microns, respectively. The difference between the two groups was not statistically significant (p>0.05%). The thicknesses of the superior, inferior, nasal and temporal quadrants of the retinal nerve fiber layer between the amblyopic and normal fellow eyes showed no statistically significant difference (p>0.05%). However, the SFCT of amblyopic eye was 11 or more microns thicker than the fellow eye and this was statistically significant different (p<0.05%). Conclusions: This study demonstrated SFCT in amblyopic eyes was significantly thicker than the normal fellow eyes. The amblyopic process may involve the choroid, but not the prepapillary NFL.

RESUMO Objetivo: comparar a espessura da coroide subfoveal (CSF) e da camada de fibra nervosa retinal (CFNR) de olhos amblíopes e normais. Design: série de casos prospectivos, transversais e observacionais. Métodos: Quarenta pacientes com idade entre 12 e 41 anos (média 23,73 ± 6,42) com ambliopia unilateral foram estudados. Entre eles, 11 (28,2%) pacientes apresentavam ambliopia secundária a estrabismo e 29 (71,8%) apresentavam ambliopia anisometrópica. Foi realizada tomografia de coerência óptica (TCO) da espessura da CFNR peripapilar do olho amblíope e do outro olho. As medidas de espessura da CFNR foram realizadas nos quadrantes superior, inferior, nasal e temporal na região peripapilar. Além disso, a espessura da coroide subfoveal (CSF) foi medida através de tomografia de coerência óptica de domínio espectral (TCO-DE). Resultados: A espessura média global da CFNR do olho amblíope e do outro olho foi de 104,48 mícrons e 102,83 mícrons, respectivamente. A diferença entre os dois grupos não foi estatisticamente significativa (p > 0,05%). As espessuras dos quadrantes superior, inferior, nasal e temporal da camada de fibras nervosas da retina entre o olho amblíope e o normal não apresentaram diferença estatisticamente significativa (p > 0,05%). No entanto, a CSF do olho amblíope foi 11 mícrons mais espessa (ou mais) do que a do outro olho - essa diferença foi estatisticamente significativa (p < 0,05%). Conclusões: Este estudo demonstrou que a CSF dos olhos amblíopes foi significativamente mais espessa do que a dos olhos normais. O processo amblíope pode envolver a coroide, mas ele não envolve a CFNR peripapilar.

Transepithelial Photorefractive Keratectomy for Low to Moderate Myopia in Comparison with Conventional Photorefractive Keratectomy.

PURPOSE: To compare the effectiveness, safety and stability of the results of transepithelial photorefractive keratectomy (tPRK) with conventional photorefractive keratectomy (PRK) for low to moderate myopia. METHODS: In this prospective non-randomized case-control study, patients with low to moderate myopia were assigned to the tPRK group (cases) or the PRK group (controls). In the tPRK group, eyes were treated using the Amaris excimer laser (SCHWIND eye-tech-solutions GmbH and Co. KG, Germany). Outcome measures included postoperative pain using McGill Pain Questionnaire, epithelial healing time, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, and safety and efficacy indexes which were compared between the study groups. RESULTS: Three hundred forty eyes of 170 patients were enrolled in this study. Each study group comprised of 170 eyes of 85 patients. There was a significant difference between the two groups regarding the postoperative pain scores in favor of the tPRK group (P = 0.04). The tPRK group had a shorter epithelial healing time than the conventional PRK group postoperatively (P = 0.01). Mean UCVA was significantly better in the case group than in the control group at the postoperative month 2 (P = 0.01). Regarding the safety and efficacy indexes, the tPRK group had better results than the conventional PRK group (P < 0.01 for both comparisons). CONCLUSION: Transepithelial PRK seems to be superior to conventional PRK for treatment of low to moderate myopia in terms of postoperative pain, epithelial healing time, visual recovery and safety and efficacy indexes.

MyoRing Implantation in Keratoconic Patients: 3 years Follow-up Data.

PURPOSE: To evaluate long-term follow-up data on implantation of a full-ring intra-corneal implant (MyoRing) for management of keratoconus. METHODS: A total of 40 keratoconic eyes of 37 consecutive patients who had undergone MyoRing implantation using the Pocket Maker microkeratome (Dioptex, GmbH, Linz, Austria) and completed 3 years of follow-up appointments were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and keratometry (K) readings were measured and evaluated preoperatively, and 3 years, postoperatively. RESULTS: No intraoperative complications were observed in this case series. Three years postoperatively, there was a significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder (P < 0.05 for all comparisons). UDVA was significantly improved from 1.14 ± 0.27 to 0.30 ± 0.21 LogMAR (P = 0.001), CDVA was also improved from 0.52 ± 0.23 to 0.18 ± 0.12 LogMAR (P = 0.001), SE was decreased by 4.35 diopters (D) and average keratometric values were reduced by 2.34 D (P = 0.001). Overall, 81% of subjects were moderately to highly satisfied 3 years after surgery and 64.90% agreed to have the fellow eye implanted with MyoRing. CONCLUSION: MyoRing implantation using the Pocket Maker microkeratome was found to be a minimally invasive procedure for improving visual acuity and refraction in the majority of the patients with keratoconus.

The Effect of Neurofeedback Therapy on Reducing Symptoms Associated with Attention Deficit Hyperactivity Disorder: A Case Series Study.

INTRODUCTION: This study aimed to evaluate the effectiveness of neurofeedback on attention deficit hyperactivity disorder. METHODS: This is a quasi-experimental study without a control group. The study population included all children aged 5 to 12 years old affected with attention deficit hyperactivity disorders in Tehran, Iran who were referred to psychiatric clinics and given the diagnosis. The sample included 12 children with attention deficit hyperactivity disorder who were selected based on their availability (non-random sampling). They received 30 sessions of neurofeedback treatment, 2 times per week. Before and after neurofeedback training, the children were evaluated and compared with the use of cognitive assessment system test. Data were analyzed using dependent T-test. RESULTS: The total mean score for pretest was 88.81 while the total mean score for the post test was 82.23. The mean in pretest for attention hyperactivity disorder was higher than the mean in the post test. Moreover, The difference of pretest and post test scores of children affected with learning disorder associated with ADHD was calculated that showed significant (P=0.003). CONCLUSION: Neurofeedback is effective in the improvement of attention deficit hyperactivity disorder.

Intrastromal corneal ring segment implantation (keraring 355°) in patients with central keratoconus: 6-month follow-up.

We evaluate the efficacy and safety of Keraring 355° intrastromal corneal ring segment (ICRS) implantation aided by PocketMaker microkeratome for the correction of keratoconus. Patients underwent ICRS insertion using mechanical dissection with PocketMaker microkeratome and completed 6 months of follow-up. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, topographic findings, safety, efficacy index, and adverse events were reported for six months postoperatively. We evaluated 15 eyes of 15 patients (12 men) with a mean age of 28.87 ± 6.94 years (range 21-49 years). At final postoperative examination, there was a statistically significant reduction in the spherical equivalent refractive error compared to preoperative measurements (-5.46 ± 1.52 to -2.01 ± 1.63 D, P < 0.001). Mean preoperative UCVA (logMAR) before implantation was 0.79 ± 0.48, and postoperative UCVA was 0.28 ± 0.15, P = 0.001. Mean preoperative BSCVA (logMAR) before implantation was 0.36 ± 0.21; at final follow-up examination BSCVA was 0.18 ± 0.9, P = 0.009. Mean K decreased from 48.33 to 43.31 D, P < 0.001. All patients were satisfied with ICRS implantation; 86.7% were moderately to very happy with the results. No intraoperative or postoperative complications were demonstrated. This preliminary study shows that ICRS (Keraring 355°) implantation is an efficient, cost-effective, and minimally invasive procedure for improving visual acuity in nipple type keratoconic corneas.