The effects of Ramadan fasting on the health and function of the eye.

BACKGROUND: Ramadan fasting may alter a variety of physiological parameters which by themselves influence ocular system. Here, we review the effects of Ramadan fasting on the health and function of the eye. MATERIALS AND METHODS: Literature records in PubMed/MEDLINE, Web of Science, EMBASE, Google Scholar, and Iran Medex databases as well as proceedings of related meetings from January 1986 to March 2014 were systematically reviewed. The search key words was based on the terms "Ramadan Fasting," "Ramadan," "Islamic Fasting," "Fasting in Ramadan" accompanied with one of the eye, tear drop, myopia, intraocular pressure (IOP), tear break up time, basal tear secretion, refractive error, and visual acuity. RESULTS: Predawn water loading and dehydration in the evening are shown to increase and decrease IOP and tear secretion, respectively. Ocular blood flow is changed in Ramadan fasting, and patients with ocular vein occlusion may experience more frequent attacks. There are no or minimal fluctuations in visual acuity and refractive errors, but most of them are decompensated after Ramadan. CONCLUSION: Although the influence of fasting in different eye parameters is evaluated in several studies, there are no or only limited studies conducted on patients suffering from glaucoma, damage to ophthalmic vasculature, tear dysfunction, and minimal visual acuity. Such studies are required to make a definite decision before fasting is declared harmless to these patients.

Bilateral bacterial keratitis in three patients following photorefractive keratectomy.

PURPOSE: To report clinical manifestations and the bacteriologic profiles of three patients with bilateral bacterial keratitis following photorefractive keratectomy (PRK). METHODS: Photorefractive keratectomy was performed for mild to moderate myopia or compound myopic astigmatism. Bandage contact lenses were fitted at the conclusion of each surgery. Bilateral infectious keratitis was diagnosed within 3 days after surgery. Smear and culture were obtained in all three cases. Patients were treated with topical fortified antibiotics (cefazolin and gentamicin). RESULTS: All patients presented with severe bilateral ocular pain, photophobia, purulent discharge, and dense corneal infiltration. Causative organisms were Staphylococcus aureus (n = 2) and Streptococcus pneumoniae (n = 1). Ulcers were controlled with aggressive medical therapy in five eyes; however, tectonic penetrating keratoplasty was required in one eye. CONCLUSIONS: Uncontrolled blepharitis and bandage contact lens use appears to play a role in the development of bacterial keratitis after PRK. Avoidance of simultaneous bilateral surgery in patients with risk factors for bacterial keratitis, preoperative control of blepharitis, and good contact lens hygiene is suggested.

Long-term outcomes of penetrating keratoplasty in chronic and delayed mustard gas keratitis.

PURPOSE: To report the long-term outcomes of penetrating keratoplasty (PKP) in war victims with chronic and delayed mustard gas keratitis. METHODS: This noncomparative interventional case series includes patients with advanced chronic or delayed mustard gas keratitis who had undergone PKP from 1989 to 2006. Best-corrected visual acuity (BCVA), graft clarity, episodes of graft rejection, duration of steroid use, and complications were evaluated. Histopathologic features of excised corneal buttons were also evaluated. RESULTS: Overall, 22 eyes of 19 patients underwent PKP. Mean age at the time of surgery was 41 +/- 4.6 years (range, 36-54 years), and mean follow-up duration was 40.9 +/- 48 months (range, 4-204 months). The graft remained clear in 17 (77.3%) eyes and failed in 5 (22.7%) eyes. Overall, 13 (59.1%) eyes experienced episodes of endothelial rejection, and 5 (22.7%) eyes had subepithelial immune rejection, 4 of which had simultaneous endothelial rejection. Fifteen (68.2%) eyes received topical steroids for >6 months. Fourteen (63.6%) eyes developed cataracts, leading to cataract extraction in 7 eyes. One eye developed steroid-induced glaucoma after multiple episodes of endothelial graft rejections. Mean preoperative BCVA was 1.92 +/- 0.63 logMAR, which improved to 1.04 +/- 0.65 logMAR (20/200) overall and 0.8 +/- 0.3 logMAR (20/120) in eyes with clear grafts (P < 0.001). Main histopathologic features of excised corneal buttons included corneal thinning and ulceration, loss of keratocytes, acute and chronic inflammation, stromal vascularization, and degenerative sequelae of long-standing inflammation. CONCLUSIONS: PKP in chronic or delayed-onset mustard gas keratitis should be considered as a high-risk graft; however, with appropriate management, graft clarity and visual outcomes may be favorable.

Prevalence of open-angle glaucoma, glaucoma suspect, and ocular hypertension in thyroid-related immune orbitopathy.

PURPOSE: To determine the prevalence of open-angle glaucoma (OAG), glaucoma suspects (GS), and ocular hypertension (OHT) in patients with thyroid-related immune orbitopathy (TRIO) and compare it with a control group. PATIENTS AND METHODS: In this cross-sectional analytic study, 233 eyes of 117 patients with TRIO (case group) and 240 eyes of 120 normal age and sex-matched individuals (control group) underwent complete ocular examinations. Grave orbitopathy (GO) was diagnosed by clinical examinations with the help of an endocrinologist and para clinic tests. Controls were selected among apparently healthy individuals with no history of previous orbitopathy or thyroid diseases. RESULTS: Prevalence of OAG and OHT was 2.5% and 8.5% in the case group, respectively. In contrast, OAG was detected in only 2 eyes (0.8%) of the control group and there were no instances of GS or OHT in the control group. Although the prevalence of OAG and GS were higher in cases than controls, this difference was not statistically significant. However, OHT was more common in cases (P<0.01). Ten eyes in the case group (4.3%) developed compressive optic neuropathy (CON); high intraocular pressure was detected in 5 of them (2.1%). All cases of OAG and GS in the case group were classified as stage 3 or higher of No symptoms or signs, Only signs no symptoms, Soft tissue, Proptosis, Extraocular muscle, Cornea, Sight loss. Active GO was only more prevalent in patients with OHT (P<0.001). CONCLUSIONS: The prevalence of OHT was higher in cases with GO than age and sex-matched controls. Ophthalmologic examinations including intraocular pressure measurement (and if needed automated visual fields) should be regularly performed in patients with GO particularly in higher stages and those with active disease.

Keratectasia after LASIK but not after PRK in one patient.

PURPOSE: To report a case of keratectasia in a patient who underwent LASIK in the right eye and photorefractive keratectomy (PRK) in the left eye for correction of compound myopic astigmatism. METHODS: A 30-year-old man underwent LASIK in the right eye and PRK in left eye for refraction of -1.75 -1.50 x 48 degrees and -1.00 -1.75 x 100 degrees, respectively. Preoperative corneal thickness was 447 microm in the right eye and 446 microm in the left eye. RESULTS: Postoperative corneal thickness decreased to 341 microm and 384 microm in the right and left eye, respectively. Uncorrected visual acuity in the left eye was 20/20, but the right eye developed keratectasia, which led to severe visual loss (20/400). CONCLUSIONS: Photorefractive keratectomy may be better than LASIK for ablative refractive surgery for low myopic astigmatism in eyes with low central corneal thickness.

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.

Prevalence of Amblyopia and Refractive Errors Among Primary School Children.

PURPOSE: To determine the prevalence of amblyopia and refractive errors among 7 to 12-year-old primary school children in Tehran, Iran. METHODS: This population-based cross-sectional study included 2,410 randomly selected students. Visual acuity was tested using an E-chart on Yang vision tester. Refractive errors were measured by photorefractometry and cycloautorefraction. Strabismus was checked using cover test. Direct ophthalmoscopy was used to assess the anterior segment, lens opacities, red reflex and fundus. Functional amblyopia was defined as best corrected visual acuity ≤20/40 in one or both eyes with no anatomical problems. RESULTS: Amblyopia was present in 2.3% (95% CI: 1.8% to 2.9%) of participants with no difference between the genders. Amblyopic subjects were significantly younger than non-amblyopic children (P=0.004). Overall, 15.9% of hyperopic and 5.9% of myopic cases had amblyopia. The prevalence of hyperopia ≥+2.00D, myopia ≤-0.50D, astigmatism ≥0.75D, and anisometropia (≥1.00D) was 3.5%, 4.9%, 22.6%, and 3.9%, respectively. With increasing age, the prevalence of myopia increased (P<0.001), that of hyperopia decreased (P=0.007), but astigmatism showed no change. Strabismus was found in 2.3% of cases. Strabismus (OR=17.9) and refractive errors, especially anisometropia (OR=12.87) and hyperopia (OR=11.87), were important amblyogenic risk factors. CONCLUSION: The high prevalence of amblyopia in our subjects in comparison to developed countries reveals the necessity of timely and sensitive screening methods. Due to the high prevalence of amblyopia among children with refractive errors, particularly high hyperopia and anisometropia, provision of glasses should be specifically attended by parents and supported by the Ministry of Health and insurance organizations.

Topographic evaluation of relatives of patients with keratoconus.

PURPOSE: To evaluate topographic corneal changes in relatives of patients with keratoconus (KCN). METHODS: In a prospective study, 300 eyes of 150 relatives of 45 patients with KCN were evaluated. Complete slit-lamp examination, refraction, and corneal topography were performed for all eyes. The topographic indices for diagnosis of KCN were from Rabinowitz criteria. RESULTS: The study included 84 (56%) female and 66 (44%) male subjects. Mean age was 32.4 +/- 15 years (range, 16-83 years). KCN was diagnosed in 14% of the subjects and another 7.3% were suspicious for KCN. The overall prevalence of astigmatism was 58%, including 42.1% in the KCN group, 66.7% in the KCN suspect group, and 49.6% in the healthy group. Thirty-one eyes had high regular astigmatism (>1.5 D) including 17 (54.8%) in the KCN group and 14 (45.2%) in the healthy group. Oblique astigmatism was seen in 33 (11%) eyes, including 34.2% in the KCN group, 47.6% in the suspicious KCN group, and 4.6% in the healthy group. CONCLUSIONS: Relatives of patients with KCN have a high prevalence of undiagnosed KCN. Corneal topography is important for the diagnosis of KCN and KCN suspects in family members of patients with KCN. Therefore, keratorefractive surgery should be considered cautiously in these individuals.

Visual outcome and ocular survival in open-globe injuries.

AIM: To detect the risk factors that predicts final visual acuity, retinal detachment, and ocular survival after penetrating trauma. METHODS: In a prospective case series study, 116 eyes with open-globe injuries were evaluated between 2001 and 2004. All data were filled in the questionnaire chart. Sex, age, involved eye, best-corrected visual acuity (BCVA), afferent pupillary defect (APD), location and wound length, cataract, iris prolapse, vitreous prolapse, retinal detachment (RD), intraocular foreign body (IOFB), vitrectomy procedure, and type of injury were evaluated as predisposing factors by logistic regression models for final visual acuity, RD, and ocular survival. RESULTS: Low BCVA, RD, and vitrectomy procedure were detected significant in the final visual acuity of 20/200 or less. APD and vitrectomy procedure were statistically significant in the final RD. BCVA 20/250 or less, wound length >10mm, scleral and corneoscleral lacerations, vitreous prolapse, vitreous hemorrhage, RD, and sharp injury were correlated with decreased globe survival. CONCLUSION: Low BCVA, APD, and vitrectomy procedure were effective in the visual outcome. RD and vitrectomy procedure were detected significant in the anatomic result. Establishment of predictors of visual outcome and ocular survival may assist clinicians in salvageable eyes for surgical repair.