Comparison of postoperative topical interferon-α2b versus intraoperative mitomycin C for pterygium recurrence prevention: a randomized clinical trial.

PURPOSE: To evaluate the effect of postoperative interferon-alpha 2b (IFN-α2b) ophthalmic drops versus intraoperative mitomycin-c (MMC) on preventing pterygium recurrence. METHODS: This prospective randomized clinical trial was conducted on patients who were candidates for pterygium surgery. A total of 75 patients were included in the study from December 2021 to December 2022, of which 64 patients (one eye each) were examined and analyzed based on the inclusion criteria. Then the patients were randomly assigned to control groups, intra-operative MMC (32 patients) and the intervention group, IFN-α2b drops after the operation (32 patients). All patients underwent pterygium surgery using the rotational conjunctival flap method. RESULTS: In terms of pterygium grading, 8 (12.5%), 25 (39.06%), and 31 (48.44%) eyes were in grades 1, 2, and 3, respectively. The average size of the pterygium was 3.6 ± 0.7 mm. The grade and size of pterygium had the same distribution in the two groups. There was no statistically significant difference between the two groups in the level of post-operative clinical inflammation. The present study showed no significant difference in complications between the two groups (p = 0.999). The recurrence rate in the control group was 9.4% (3 eyes), and 0% (no recurrence) in the intervention group (p = 0.119). CONCLUSIONS: interferon-alpha 2b group did not show a statistically significant difference in preventing pterygium recurrence compared to the mitomycin C group. The post-surgery administration of IFN-α 2b drops can effectively prevent pterygium recurrence with a comparable and even more compelling effect than MMC during surgery.

Prevalence of cataract and its contributing factors in Iranian elderly population: the Gilan eye study.

PURPOSE: To report the prevalence and the associated factors leading to cataract among the Iranian population living in Gilan Province, Iran. METHODS: This population-based cross-sectional study was performed from June to November 2014 on 2,975 residents aged ≥ 50 years old living in urban and rural regions of the Gilan Province in Iran. A representative sample of residents in the province was recruited into the study through door-to-door visiting, and baseline data were collected by questionnaire. All participants were referred to the medical center for comprehensive ophthalmic examination, laboratory tests, and blood pressure measurement. RESULTS: Among the population, 2,588 (86.99%) subjects were eligible to be included in this study, categorized either into the cataract or the non-cataract group. The mean age of participants was 62.59 ± 8.92 years, and 57.5% were female. Higher prevalence of cataract was found in individuals of older ages (odds ratio (OR) = 1.13; 95% confidence interval (CI) = 1.10 to 1.16; P < 0.001) and a history of previous ocular surgery (OR = 5.78; 95% CI = 2.28 to 14.63; P < 0.001). At the same time, a lower prevalence of cataract was seen in patients exposed to sunlight for more than 4 h per day (OR = 0.49; 95% CI = 0.32 to 0.73; P = 0.001). CONCLUSION: Cataract affects 50.50% of the study population, especially those over 80. The mildest form of cataract, grade zero, is the most common. Surgery for cataract has good outcomes. The risk of cataract is higher for those older or who have had eye surgeries. People not affected by cataract tend to be exposed to more sunlight.

The Cutoff of Ferritin for Evaluation of Hypothyroidism in Patients With Thalassemia.

BACKGROUND: Thalassemia major is a genetic disease with a recessive autosomal pattern of inheritance that occurs as a result of disorder in hemoglobin synthesis. Researchers aimed to investigate the cutoff of ferritin for the development of hypothyroidism in patients with thalassemia major. MATERIALS AND METHODS: This was a retrospective analytic cross-sectional study that was conducted on the medical records of patients with thalassemia major. Overt hypothyroidism was defined as thyroid stimulating hormone (TSH) level of >6.5 mIU/L and T4 level of < 4.2 ng/dL and subclinical hypothyroidism was defined as TSH level of >6.5 mIU/L and T4 level of >4.2 ng/dL. Data were gathered by a form including age, sex, weight, height, body mass index, thyroid test results, and the mean of last 3 consecutive hemoglobin and ferritin levels. RESULTS: In this study, 67 patients were evaluated. The mean age of the participants was 15.37±3.73 years. The frequency of subclinical hypothyroidism was 10.4%, and no cases of clinical hypothyroidism were noted as well as secondary hypothyroidism. Although there was a significant linear correlation between mean ferritin level and TSH (P=0.008), no significant correlation was noted between levels of ferritin and T4 levels. As ferritin was significantly correlated with TSH, the results showed that the mean serum level of ferritin in ß-thalassemia major patients with hypothyroidism was higher than that in ß-thalassemia major patients with normal thyroid status (P=0.013). The cutoff point for ferritin was 1953 ng/mL (sensitivity=85.7%, specificity=60%). CONCLUSION: It seems that considering the development of hypothyroidism by reaching the ferritin cutoff point, intensification of the iron chelation regimen along with a shorter interval for laboratory endocrine examinations can be recommended.

Closantel retinal toxicity: Recovery from severe vision loss after corticosteroid therapy.

PURPOSE: To present a relatively rare case of retinal toxicity and consequent severe vision loss due to Closantel ingestion. CASE REPORT: A 37-year-old female presented with sudden painless decrease vision in both eyes. She had no previous history of medical disease and denied any trauma. The patient had accidentally ingested Closantel a few days prior to presentation. Closantel is a veterinary anti-helminthic drug used mainly in livestock. Best corrected visual acuity (BCVA) at presentation was 20/200 bilaterally. There was no relative afferent pupillary defect (RAPD) and red saturation test was normal. Macular optical coherence tomography (OCT) revealed disruption in the outer retinal layer and ellipsoid zone in both eyes. A diagnosis of retinal toxicity due to Closantel was made and the patient was started on 1 mg/kg oral prednisolone acetate. On the 45th day after presentation, her BCVA had improved to 20/20 bilaterally. CONCLUSION: Closantel is a potentially toxic drug causing destruction of the neurosensory retina and visual disturbances. We suggest eye-care personnel awareness regarding the risk of Closantel-induced retinal toxicity and prompt treatment with systemic steroids should be considered.

The Preventive Role of Atropine Eye Drops on Myopia Progression: A Double-Blind Randomized Clinical Trial.

Background: In the present study, we investigated the effect of two doses of atropine eye drops versus placebo on myopia progression in children and adolescents. Methods: In this double-blind, randomized clinical trial, 67 patients aged 6 to 18 years with myopia of -2 to -6 D were enrolled and randomized to receive a placebo eye drop, atropine 0.1%, or 0.01% ophthalmic solution (one drop per night for 6 months). All participants were followed-up with for one year after the beginning of the study (at zero, one, three, six, and 12 months) and their spherical equivalent (SE), axial length (AL), anterior chamber depth (ACD), and far and near visual acuity (VA) and the eye drops side effects were recorded. A comparison among the groups was performed using SPSS software, version 24.0. Results: Spherical equivalent, AL, and ACD decreased and far VA improved in atropine groups to a greater extent than the placebo group (P < .05) at the 6-month follow-up. The most common side effects of atropine 0.1% eye drop included photophobia and decreased near VA. At the end of the study (six months after the cessation of atropine), a rebound effect was observed; this effect was especially severe in the 0.1% atropine group. Conclusions: Atropine eye drops are effective for slowing down and preventing myopia progression. However, without long-term treatment, they will have a rebound effect. A lower dose (0.01%) is suggested for reducing the side effects and rebound effects.

Role of Overcorrecting Minus Lens Therapy in Intermittent Exotropia for Prevention of Constant Exotropia in Children Under the Age of 7 Years.

Background: The basis of the overcorrecting minus lens is to induce compliance and consequently prevent constant exotropia. Some previous studies advocated early surgical therapy and others suggested over-minus treatment. Our purpose is to evaluate the success rate of the over-minus lens. Methods: This descriptive cross-sectional study was carried out on 106 patients under the age of 7 years with intermittent exotropia (IXT) who attended Amir-Al-Momenin Hospital at Guilan University of Medical Sciences, Iran. The data was gathered by a form including sex, age, level of cycloplegic refraction, the amount of deviation before and after using the over-minus glasses, visual acuity, the amount of the over-minus glasses, duration of treatment, recovery, and follow-up. The success rate was defined as decreasing exotropia to less than ten prism diopters or exophoria. Results: A total of 106 patients with a mean age of 2.25 ± 0.74 years were enrolled in this study. The mean exotropia before and after treatment was 20.96 ± 8.20 and 12.16 ± 11.04 prism diopters, respectively, and there was a statistically significant difference (P < 0.002). The mean refractive spherical and astigmatic errors (cycloplegic refraction) were +1.34 ± 1.07 and -0.32 ± 0.72 diopters, respectively. At the end of the follow-up, exotropia increased in 5.6% of patients, there was no change in 15% of patients with a mean deviation of 25.0 ± 6.06 prism diopters, and 79.24% of patients were treated successfully. Conclusions: According to the results of this study, treatment of IXT by over-correcting lenses can be a safe procedure and effective in preventing exotropia.

Corneal Astigmatic and Refractive Changes after Rectus Muscle Surgery.

Objective:In the present study, we investigated the postoperative astigmatic and refractive changes in patients with rectus muscle strabismus surgery. Materials and methods:Ninety-three eyes of 51 patients who underwent strabismus surgery at Amir- Almomenin Hospital, Rasht, Iran, were enrolled. The ocular measurements before surgery as well as one month, three and six months postoperatively included cycloplegic refraction, the degree of near and far deviation, mean corneal power, mean keratometry, spherical equivalent (SE) and the change of astigmatism cylinder (measured using power vector analysis). All data were analyzed using SPSS software, version 21. Results:The mean age of participants was 18.31±14.58 years. A similar myopic shift was observed in all deviation groups. The mean SE values differed according to the type of surgery one month and three months postoperatively, with maximum change being seen in medial rectus (MR) recess + inferior oblique (IO) myectomy and in MR recess and lateral rectus (LR) recess six months after surgery. The change in mean J0 remained significant six months postoperatively only in MR recess surgery and in medial and lateral rectus recess groups based on topography (both P<0.001). The postoperative J0 and J45 differed according to the type of surgery (PP<0.001 and 0.007, respectively). The mean keratometry was different before-after LR recess (the minimum change), MR recess and MR recess + IO myectomy groups (the maximum change; PP<0.05). Conclusion:Refractive error toward myopic shift and with-the-rule (WTR) astigmatism are common after strabismus surgery on the rectus muscles, most of which sustain until six months postoperatively.

Clinical outcomes of viscocanalostomy and phacoviscocanalostomy in primary open angle glaucoma: Two years follow-up.

PURPOSE: To compare the outcomes of phacoviscocanalostomy and viscocanalostomy in patients with primary open angle glaucoma. METHODS: This non randomized, prospective comparative study included 168 eyes of 168 patients with primary open angle glaucoma (POAG). Phacoviscocanalostomy was performed in 94 eyes with POAG and cataract and viscocanalostomy was performed in 74 eyes with POAG. Preoperative and postoperative intraocular pressures (IOP), number of antiglaucoma medication, intraoperative and postoperative complications were recorded throughout the follow-up period. RESULTS: The mean follow-up after surgery was 20.13 ± 7.9 months. Mean IOP decreased significantly 1 month after surgery in both groups (p < 0.001) and remained significantly lower from its preoperative value at all follow-up visits. The postoperative mean IOP at the last follow up in phacoviscocanalostomy and viscocanalostomy was 14.98 ± 4.8 mmHg and 16.84 ± 5.0 mmHg, respectively (p = 0.001). Complete success rate in phacoviscocanalostomy and viscocanalostomy groups was 83.1% and 56.8%, respectively (p = 0.008). Qualified success rate was achieved in 89.4% eyes in the phacoviscocanalostomy group and 83.8% of viscocanalostomy group (p = 0.534). The Best corrected visual acuity (BCVA) in phacoviscocanalostomy group improved significantly post-operatively (p = 0.001). Postoperative antiglaucoma medication in both groups were significantly less than the preoperative values (p = 0.001). CONCLUSIONS: Both Phacoviscocanalostomy and viscocanalostmy are effective procedures in the control of IOP in patients with POAG with and without cataract. Higher complete success rates and BCVA were achieved in phacoviscocanalostomy. Therefore, phacoviscocanalostomy and viscocanalostomy are recommended in eyes with medically uncontrolled primary open-angle glaucoma with and without coexisting cataract.

Retinopathy of prematurity: applicability of international and national screening guidelines in the north of Iran.

BACKGROUND: To determine the applicability of current international and national retinopathy of prematurity (ROP) screening guidelines and to identify a suitable community-based screening criterion. METHODS: A retrospective study on premature neonates (≤37 weeks gestation) referred to a tertiary eye hospital ROP clinic in the north of Iran was conducted over a 10-year period. Neonates were classified as no ROP, with ROP and type 1 ROP. Data consisting of birth weight (BW), gestational age (GA) and chief risk factors were evaluated. Various screening criteria and currently established screening guidelines were applied and compared for applicability using a receiver operating characteristic curve. RESULTS: A total of 716 neonates with a mean GA of 31.4 ± 2.8 weeks and BW of 1629 ± 502 grams were screened. The incidence of ROP was 22.9% and type 1 ROP requiring treatment was 0.28%. When applying the national Ministry of Health Guidelines, all neonates with type 1 ROP requiring treatment were identified; These criteria had a specificity of 7% for the diagnosis of type 1 ROP, and a large number of neonates (n=645) who are not at risk for type 1 ROP will be redundantly screened. Guidelines of the American Academy of Pediatrics and the UK would miss 4.5% of patients requiring ROP treatment. According to our data a threshold of GA≤32 weeks and/or BW ≤1600 grams demonstrated a sensitivity of 95.7% and specificity of 33.6% for the diagnosis of any ROP and a sensitivity of 100% and specificity of 26.8% for type 1 ROP requiring treatment. CONCLUSIONS: The ideal ROP screening guideline is one that is very sensitive and identifies patients requiring treatment without delay. To minimize redundant screening while maintaining optimum ROP requiring treatment diagnosis, we proposed a new local evidence-based screening guideline.

Evaluation of Choroidal Thickness during Pregnancy and Postpartum: A Longitudinal Study.

Purpose: To assess the longitudinal changes of choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT) during pregnancy and postpartum. Methods: The study included 23 eyes of 23 healthy pregnant women and 23 eyes of 23 healthy nonpregnant women. Choroidal thickness was measured manually with EDI-OCT at seven locations: The fovea, 500, 1000, and 1500 µm temporal (T) from the fovea and 500, 1000, and 1500 µm nasal (N) from the fovea. Measurements were obtained at each pregnancy trimester and 6 weeks postpartum and in the follicular phase of the menstrual cycle for the control group. Results: The mean subfoveal choroidal thickness was 410.2 ± 82.4 µm, 434.8 ± 79.6 µm, 433.5 ± 80.3 µm, and 395.0 ± 71.1 µm in the first, second, and third trimesters and 6 weeks postpartum, respectively. In all seven measured locations, statistically significant changes were noted during pregnancy and postpartum in the choroidal thickness (P < 0.001). Choroidal thickness increased from the first trimester to the second and third trimester, after which it decreased at postpartum. Choroidal thickness was greater in the pregnant group during pregnancy and postpartum compared to the control group (P < 0.001). Conclusions: This study indicated significant change in choroidal thickness at seven locations measured with EDI-OCT throughout pregnancy and 6 weeks after delivery. We showed that 6 weeks after delivery, choroidal thickness remains significantly higher than nonpregnant subjects.

Macular Optical Coherence Tomography before Cataract Surgery.

PURPOSE: To determine the benefits of performing preoperative spectral domain optical coherence tomography (SD-OCT) and to identify occult macular pathologies in patients scheduled for routine cataract surgery. METHODS: In this cross-sectional study, macular SD-OCT scans were performed on all patients with clinically undetected macular abnormalities who were scheduled for cataract surgery. Patients with clinically evident macular abnormalities were excluded from the study. A retinal specialist reviewed all the scans. The severity of the cataract was determined using the Oxford Clinical Cataract Classification and Grading System. RESULTS: Of the 598 evaluated cases, 33 patients (5.52%) had an occult macular abnormality. The most common pathology found in these patients was idiopathic epiretinal membrane, which was detected in 17 eyes (51.52%), followed by vitreomacular traction in nine eyes (27.27%), and dry age-related macular degeneration in four eyes (12.12%). Full-thickness macular holes and a lamellar macular hole were found in two patients (6.06%) and one patient (3.03%), respectively. The frequency of cortical cataracts was significantly lower in patients without macular lesions (P = 0.012) than in those with macular lesions. Multivariate logistic regression analysis revealed that age >70 years (P = 0.025 and odds ratio [OR] =11.12), smoking history (P = 0.043 and OR = 3.43), and hypertension were independently associated with occult macular lesions. The surgical plan was changed for five patients (0.83%). CONCLUSIONS: Macular SD-OCT can be used to detect occult macular lesions and provide useful information about a macula before cataract surgery. Although preoperative OCT found macular abnormalities in about 5% of patients with presumed normal fundus examination, it can result in changing the surgical plan in 0.83% of all patients.

Outcomes of Phaco-viscocanalostomy in Primary Open Angle Glaucoma versus Pseudoexfoliation Glaucoma.

PURPOSE: Viscocanalostomy represents an alternative to standard penetrating glaucoma surgery. The aim of this study is to compare the outcomes of combined phacoemulsification and viscocanalostomy in eyes with primary open-angle glaucoma (POAG) versus eyes with pseudoexfoliation glaucoma (PEXG). METHODS: In this prospective non-randomized comparative study, eyes with cataract and POAG or PEXG were enrolled. Pre- and postoperative data including best corrected visual acuity (BCVA), intraocular pressure (IOP), and the number of antiglaucoma medications administered were recorded at each visit. All patients underwent phacoviscocanalostomy. Complete success was defined as the IOP of 21 mmHg or less without the administration of medication while a qualified success reported the same IOP parameters either with or without the administration of medication. RESULTS: Fifty-four eyes with POAG and fifty-four with PEXG underwent phacoviscocanalostomy. The mean follow-up time was 23.36 ± 8.8 months (range, 6-40 months). The mean postoperative IOP reduced significantly in both groups, although the mean IOP reduction was significantly greater in PEXG eyes (14.7 ± 8.9 vs 10.1 ± 7.7 mmHg) (P = 0.05). At the final follow-up visit, the mean postoperative IOP was 14.1 ± 2.1 and 16.6 ± 3.5 mmHg in the PEXG and POAG eyes, respectively (P = 0.001). A complete success rate of 88.9% and 75.9% was achieved in PEXG and POAG eyes, respectively (P = 0.07). The qualified success rate was 100% in the PEXG and 85.2% in POAG groups (P = 0.03). CONCLUSION: Phacoviscocanalostomy achieved significant IOP reduction and visual improvement in both POAG and PEXG patients. Our results indicated that in terms of IOP reduction, this procedure was more effective in treating PEXG.

The Outcome of Corneal Collagen Cross-Linking in Patients with Advanced Progressive Keratoconus: A 2-Year Follow-up Study.

PURPOSE: The aim of this study was to evaluate the safety and efficacy of collagen cross-linking (CXL) in advanced progressive keratoconus with a maximum keratometry (Kmax) value of more than 58 diopters (D). METHODS: This prospective interventional case series involved patients with advanced progressive keratoconus with a Kmax of more than 58 D. The best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), Kmax, mean keratometry (Kmean) value, corneal astigmatism, and thinnest corneal thickness before surgery and 24 months after CXL were determined for 30 eyes of 27 patients. A Pentacam was used to measure the paraclinical parameters. RESULTS: The mean age of the patients was 24.47 ± 3.33 years. The mean logarithm of the minimum angle of resolution (logMAR) of the uncorrected visual acuity UCVA decreased from 0.73 ± 0.36 D at baseline to 0.48 ± 0.30 D (P = 0.01), while the mean thinnest point thickness of the cornea decreased from 438.65 ± 40.11 µm to 431.43 ± 61.92 µm (P = 0.005) after 24 months. The decreases in the mean logMAR of the BCVA, Kmax and Kmean values, and corneal astigmatism were not statistically significant (P > 0.05) at the 24-month follow-up. Progression was halted in 29 eyes (96.6%); only 1 eye (3.3%) showed an increase in the Kmax value of more than 2.0 D, which was indicative of treatment failure. In contrast, most other eyes showed a decrease in the Kmax value although it was not statistically significant. There were no major complications in any of the patients during the study period. CONCLUSION: Standard CXL treatment was safe and stabilized both the visual acuity and tomographic parameters at the 2-year follow-up in eyes with advanced progressive keratoconus.

Correlation of corneal elevations measured by Scheimpflug corneal imaging with severity of keratoconus.

PURPOSE: To evaluate the correlation of corneal elevation and difference elevation with severity of keratoconus. METHODS: Anterior and posterior corneal elevations with both conventional and enhanced best-fit spheres (using rotating Scheimpflug camera) were measured. Front and back difference elevation were extrapolated from difference map of Belin/Ambrosio Enhanced Ectasia Display of the Scheimpflug system. Data from corneal elevations and difference elevations were correlated with maximum keratometry, minimal corneal thickness, and severity of keratoconus as assessed by Amsler-Krumiech classification of keratoconus. RESULTS: Ninety eyes of 55 keratoconus patients of different clinical stages were evaluated. There was a significant positive correlation between keratoconus severity and corneal elevations (anterior and posterior elevation as measured with both conventional and enhanced best-fit spheres) and also between keratoconus severity and corneal elevation differences (P < 0.001 and r > 0.625 for all). Maximum keratometry (Kmax), mean keratometry (Kmean), and all corneal elevations and difference elevations were highly correlated (P < 0.001 and r > 0.840 for all). A significant negative correlation was found between minimum corneal thickness and all corneal elevations and difference elevations (P < 0.001 and r < 0.711 for all). Receiver operating characteristic (ROC) curve analyses showed that anterior and posterior difference elevations have the best predictive accuracy for grading keratoconus severity. CONCLUSION: Evaluation of corneal elevation and difference elevation data obtained from Scheimpflug corneal imaging is useful for grading severity of keratoconus.

The epidemiological characteristics of patients with thyroid eye disease in a referral center in northern Iran.

PURPOSE: This study was conducted to determine the demographics, clinical features, severity, and activity of thyroid eye disease (TED) in patients of a referral center in the north of Iran. METHODS: Patients with TED who were referred to Amir-Almomenin Hospital, Rasht, Iran from March 2012 to March 2014 were enrolled in this cross-sectional study. The measurements of proptosis, lid width, lagophthalmos, extraocular muscle function, and visual acuity were recorded. The activity of ophthalmopathy was scored according to the clinical activity score (CAS). RESULTS: TED was diagnosed in 103 patients with a mean age of 42.1 ± 13.91 years. Of those patients, 52.4% were women, and 80% had hyperthyroidism. The mean duration of TED was 36.5 ± 53.12 months. Extraocular muscle involvement (98%) and eyelid retraction (88.3%) were the most common manifestations. Per the CAS results, 86 (83.5%) patients were at stage 0, and there was a significant difference in CAS scores between male and female patients, P = 0.02. CONCLUSIONS: The characteristics of TED in patients of the studied referral center during a two-year period, including common signs and symptoms, disease duration, treatment, an activity of disease were determined. Notably, many patients in this study had orbital squeal of TED meaning that they had inactive TED. Proper management of this serious complication requires close cooperation between endocrinologists and ophthalmologists to ensure timely referrals for appropriate care.

Survey of Nerve Fiber Layer Thickness in Anisometropic and Strabismic Amblyopia.

. To investigate the effect of anisometropic and strabismic amblyopia on the nerve fiber layer thickness. This cross-sectional study was done on 54 amblyopic subjects, equally in both strabismic and anisometropic groups. The thickness otonerve fiber layer measured in superior, inferior, nasal, temporal quadrants and as a whole in both eyes of both groups. The means of thickness were compared in amblyopic and sound eyes. In strabismus group, the average nerve fiber layer thickness of the sound eye , in superior, inferior, nasal and temporal quadrants and as a whole were 113.23±14, 117.37±25, 68.96±6, 69.55±14 and 93.40±8 microns respectively. In amblyopic eyes of the same group, these measurements were 103.11±18, 67.74±11, and 69.59±16 and 89.59±12 microns in superior, inferior, nasal, temporal quadrants and as whole respectively. In anisometropic groups, the sound eye measurements were as 130.96±22, 129.07±29, 80.62±12, and 83.88±20 and 107.7±13 microns in superior, inferior, nasal and temporal quadrants and as a whole orderly. In amblyopic eyes of this group the mean thicknesses were 115.63±29, 133.15±25, 78.8±15, 80.2±16 and 109.17±21 microns in superior, inferior, nasal, temporal quadrants and as a whole respectively. Statistically, there were no significant differences between amblyopic and sound eyes (P>0.5). Our study did not support any significant change in a nerve fiber layer thickness of amblyopic patients; however, decreased thickness in superior and nasal quadrants of strabismic amblyopia and except inferior quadrant and as a whole. These measurements may be a clue for management and prognosis of amblyopia in old age.

Birth Weight as a Cardio Metabolic Risk Factor in Iranian Adolescents.

BACKGROUND: A large number of epidemiological studies from different geographical regions showed a considerable relationship between low birth weight (LBW) and adverse health effects later in life. This study aims to assess the birth weight (BW) as a cardio metabolic risk factor in Iranian adolescents. METHODS: This cross-sectional study was conducted on 12-year-old students from different areas of Rasht, North Iran. Data were collected by a questionnaire including variables as birth height, BW, gestational age, blood pressure, and laboratory tests including triglycerides (TGs), total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and insulin level. Data were analyzed using t-test, Chi-square, and Pearson correlation coefficient. RESULTS: Overall, 858 adolescents participated in this study. Results showed significant correlation between BW and abdominal circumference, hip circumference, total cholesterol, TG, HDL-C and LDL-C (P = 0.064, 0.194, 0.224, 0.017, and 0.017, respectively). CONCLUSIONS: The study findings on the correlation between BW and cardio metabolic factors might serve as confirmatory evidence on the association of LBW with future cardio metabolic disorders.

The relationship between blood pressure, anthropometric indices and metabolic profile in adolescents: a cross sectional study.

OBJECTIVE: To investigate the relationship between blood pressure, anthropometric indices and metabolic profile in adolescents. METHODS: The present cross sectional study was conducted in 1005, 12-y-old junior students referred to 15 urban health centers of Rasht. Samples were recruited randomly and data were collected in a form which consisted of demographic characteristics, history of disease in samples and their immediate families, birth weight, physical examination and clinical examination including height, weight, blood pressure and body mass index. Also, metabolic profiles including fasting blood sugar (FBS), blood sugar (BS), cholesterol, and triglyceride (TG), low density lipoprotein (LDL), high-density lipoprotein (HDL) and insulin levels were measured. Data were analyzed in SPSS software, by descriptive and analytic statistics and p value 0.05 was considered statistically significant. RESULTS: Eight hundred fifty nine adolescents consisting of 550 (64 %) boys and 309 (34 %) girls participated in this study; 11.4 % (84/739 cases) of the participants had hypertension. The strongest correlation was seen between systolic blood pressure and weight, waist or hip circumferences and insulin levels. Also, FBS had very weak correlation with blood pressure. CONCLUSIONS: Thus, weight, waist and hip circumferences, insulin levels, high TG and low HDL have been indicated as the strongest correlating factors for high blood pressure.Thus, these factors should be investigated in high risk children and followed in hypertensive child to monitor cardiometabolic risk factors.

Results of nasolacrimal duct probing in children between 9-48 months.

Congenital nasolacrimal duct obstruction (CNLDO) is a common disease in children. The classic treatment of CNLDO is probing that was done around one year old. However, controversy exists regarding the outcome of probing in children older than one year. This study aimed to find the cure rate of initial probing for CNLDO and identify factors producing the failure rate in old age. In this retrospective interventional case series study, 100 eyes of 92 patients aged 9-48 months with CNLDO underwent probing with general anesthesia. According to the intraoperative results of probing, CNLDO were categorized in two groups of membranous obstruction at the end of nasolacrimal duct obstruction (NLD) and complex obstruction at canaliculus, lacrimal sac and N LD. Patients were categorized in three groups according to the age of probing into under 12, 12 to 24 and over 24 months. Success rate was defined as successful irrigation of NLD intraoperatively and absence of lacrimation and discharge at 1 week, one, three and six months postoperatively. The average age of patients and probing were 47.35±25.59 and 17.32±7.85 months respectively. Membranous obstruction accounted for 72% of patients and remainder had complex type. An overall cure rate of 91%, 89% and 60% was found in patients aged 9-12, 12-24 and 24-48 months respectively. Surgery success rate after six months was 91% in membranous group and 52% in complex group. There was a significant relation between the type of obstruction and opening of NLD (p<0.O01). This study showed that the probing failure of probing after one year was related to the complexity of obstruction rather than the age of the patient. It is recommended that probing could safely be done in under 4 years old.

Congenital hypothyroidism: etiology and growth-development outcome.

One of the most preventable causes of mental and growth retardation is congenital hypothyroidism (CH). This study tries to investigate growth and mental outcome of patients with CH. Since November 2006 and November 2007 in Guilan province, north of Iran, all neonates who were diagnosed with CH, evaluated for etiology of CH by laboratory follow up, thyroid sonography or scan. Growth and development of patients with CH were compared with healthy children in same age, geographical area, social and economical classes in four years old. Demographic characteristics including height, weight, and head circumference at birth, follow up time (four years old) and IQ (Good enough test) were recorded in questionnaires. Among 28904 screened neonates, 37 patients with CH were diagnosed. Incidence of CH was 1:781 in live births, 20 (54%) in female neonates and 17 (46%) in male neonates. The incidences of permanent and transient hypothyroidism were 43.2% (16 cases) and 56. 8% (21 cases) respectively. The incidence of permanent and transient hypothyroidism were 16 (43.2%) and 21 (56, 8%), respectively. In permanent CH, 11 cases (%.68.2) had dyshormonogenesis and 5 cases (%.31.2) had thyroid dysgenesis. Significant statistical difference was only in family history of thyroid disease (34, 3% Positive family history in CH vs. 13.2% in control group, P-value 0.03). All other demographic characteristics and IQ had no statistical difference. Patients with CH diagnosed through neonatal screening and treated had normal growth as general population that indicates effective screening program and treatment in this area (3.2%).