Comparison of visual outcomes, keratometric parameters and biomechanical profiles between deep anterior lamellar keratoplasty with big-bubble technique vs. Melles technique for keratoconus: a retrospective study.

OBJECTIVE: Comparing results of two different DALK surgery techniques (big bubble vs. Melles) in patients with advanced keratoconus. DESIGN: a retrospective comparative clinical study. PARTICIPANTS: This study conducted on 72 eyes of 72 participants. INTRODUCTION: This study designed to compare the results of two different DALK surgery techniques (big bubble vs. Melles) in patients with advanced keratoconus. METHOD: Thirty-seven eyes were treated using the big bubble DALK method, while 35 eyes were treated using the Melles approach. Uncorrected visual acuity (UCVA), best corrected spectacle visual acuity (BCSVA), manifest refraction, keratometric characteristics, contrast sensitivity, corneal aberrations, corneal biomechanical characteristics, and endothelial cell profile are the outcome measurements. RESULTS: Mean UCVA in big bubble group was 0.61 ± 25 LogMAR and in Melles group was 0.89 ± 0.41 LogMAR (p-value 0.043). Mean BCSVA in big bubble group (0.18 ± 0.12 Log MAR) was significantly better than Melles group (0.35 ± 0.16 Log MAR). Mean of sphere and cylinder refraction showed no significant difference between two groups. Comparing the endothelial cell profile, corneal aberrations, corneal biomechanical properties and keratometry had no significantdifferences. Contrast sensitivity reported as modulation transfer function (MTF) showed higher values in big bubble group and differences with Melles group weresignificant. Results of point spread function (PSF) in big bubble group had superiority to Melles group with considerable statistical P value of 0.023. CONCLUSION: When opposed to the Melles approach, the big bubble technique generates a smooth interface with less stromal residue, which results in higher visual quality and contrast sensitivity.

Intracorneal Stromal Ring Can Affect the Biomechanics of Ectatic Cornea.

PURPOSE: The biomechanical properties of ecstatic cornea undergo changes. This study evaluates the biomechanical changes of ecstatic cornea after implantation of two types of intracorneal stromal ring (ICR). METHODS: For doing this prospective cross-sectional study, 32 patients with keratoconus (KCN) were randomly divided into two 16-member groups (group I: MyoRing, group II: KeraRing). The main inclusion criteria were transparent cornea with no scar in the central part, corneal thickness >450 µ in the incision region, keratometry within 48-52 diopters, and progressive course of corneal thinning. Biomechanics of the cornea was evaluated by "ORA" and "Corvis" devices. All of the data were recorded and analyzed before implantation of the rings and 6 months thereafter. RESULTS: The mean ages of patients of groups I and II were 26 ± 6.55 and 33.86 ± 8.5, respectively. The postoperative change of sphere refraction was significant in both groups. However, reduction in the astigmatism was significant only in group I. In addition, the change of flat meridian keratometry (Kf) was significant before and after ring implantation in group I, unlike group II. The changes in CH and CRF parameters (ORA) were not significant in either group before and after the operation. Besides, only HRC parameter (Corvis) decreased significantly in both groups before and after the operation. CONCLUSION: Both MyoRing and KeraRings have positive effects on the biomechanics of cornea at least during the first year after implantation. Comparison of these two types of ICR did not show significant differences in Corvis and ORA parameters.

Endogenous Candida Endophthalmitis as a Rare Complication of Trans-Urethral Lithotripsy in a Healthy Woman: A Case Report

Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.

Expression of interleukin-6 in ocular surface squamous neoplasia.

PURPOSE: Interleukin-6 (IL-6) is an important cytokine in the cascade of inflammation and cancer progression. The aim of this study was to identify IL-6 expression in ocular surface squamous neoplasia (OSSN) in comparison with non-neoplastic conjunctival tissue. METHODS: Twenty paraffin-embedded tissue sections of conjunctiva from patients with OSSN including conjunctival intraepithelial neoplasia (CIN) in all grades of severity and squamous cell carcinoma (SCC) were assessed by immunohistochemistry staining for IL-6. Twenty non-neoplastic conjunctival sections from age matched patients were selected as the control group. Tissues with more than one focus of inflammatory cell infiltration were excluded from the study. The mean area of positive staining was recorded and the intensity of staining was scored in both groups and compared by statistical methods. RESULTS: The mean staining area in the dysplasia group was significantly more than non-neoplastic conjunctival tissue (63.5±25.96 and 30±15.98 percent respectively; P-value of <0.0001). Nuclear staining was observed in both groups and the difference was not statistically significant. CONCLUSION: IL-6 expressed more in the dysplastic group in compare to non-neoplastic conjunctiva and can therefore be used to diagnose dysplastic state of the conjunctiva; however, in our study, intensity of staining does not correlate with the severity of dysplasia statistically; most probably because of a low sample size in each category. The role of nuclear staining is not clear. Our findings can be an introduction toward targeted treatment of ocular surface neoplasia by the aim of newer anti-IL agents. Further investigation is needed.

Corneal wasp sting: A case report and review of literature.

PURPOSE: To report severe immunologic and toxic reaction due to corneal wasp sting that may cause catastrophic sight-threatening outcomes. METHODS: A 45-year-old man referred to the emergency room with corneal wasp sting of Vespa Orientalis. The authors review previous Medline literature about this topic. RESULTS: In our case, the response to frequent topical corticosteroid was dramatic, and at the seventh day after injury, all inflammatory responses in the anterior segment of the eye had been resolved. CONCLUSION: Corneal wasp injury with Vespa Orientalis can cause severe inflammation of the cornea and the anterior segment. Topical corticosteroids are the mainstay of treatment.

Mirror image hypermetropic anisometropia in a pair of monozygotic twins.

In monozygotic twins two embryos are formed from a single fertilized egg. In "mirror image twins" identical siblings have reverse asymmetric features in the right and left sides of the body. We report the case of twins with mirror-image hypermetropic anisometropia. They were referred to an ophthalmologist at the age of 3.5 years for amblyopia. Cycloplegic refraction of twin 1 was +1.00 in the right eye and +4.50 -0.75 ×180 in the left eye; of twin 2, +4.75 -1.00 ×180 and +1.25. Keratometry and axial length were measured with Lenstar LS 900 when the twins were 6 years of age. In twin 1, the axial length was 22.18 mm in the right eye and 20.97 in the left eye; in twin 2, 20.94 mm and 22.13. Keratomtry of both eyes of these twins was relatively equal.

Herbal Medicines and Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study.

Background. The aim of this study was to assess the association between herbal medication and OHSS. Methods. This retrospective cohort study was conducted with 101 polycystic ovary syndrome patients. 66 patients took conventional pharmacological medications and 35 took herbal medications. Data were analyzed by statistical test including Fisher's Exact and binominal logistic regression. P < 0.05 was considered significant. Results. Of the 101 females, 53 were married and 48 were single. There was no significant association between the groups in marriage. No significant association was found in mean age between the two groups (23.9 ± 5.8 years in the control group versus 26.3 ± 6.7 years in the case group). There was a significant difference between the two groups .After adding the dependent (OHSS prevalence) and independent (marriage and group) variables into the model, the Hosmer-Lemeshow test showed suitability. Variances analyzed with this model ranged between 29.4% and 40.7%. Conclusion. The indiscriminate use of herbs is correlated with OHSS. Because patients increasingly consume herbs, they should be aware of potential side effects. However, appropriate dosages of herbs could be obtained for use instead of conventional treatments, which often have side effects.

Effects of Prepubertal Acute Immobilization Stress on Serum Kisspeptin Level and Testis Histology in Rats.

Stress has inhibitory effect on HPG axis through increasing cortisol serum level. In this study, the effect of acute prepubertal stress on kisspeptin, which plays essential role in puberty achievement is assessed. To do this experimental study thirty immature healthy male wistar rats of 4 weeks old and without any symptoms of puberty were selected randomly. These rats were divided into three groups, randomly. Two groups were chosen as control and pretest and one as stress (test) group. Immobilization stress was applied for 10 days and serum level of cortisol, testosterone and kisspeptin were measured. Primary and secondary spermatocyte and sertoli cell evaluated and compared among groups. Mean serum level of kisspeptin in pretest group, control group and stress (test) group were 0.0381 ± 0.0079, 91.0500 ± 4.87430 and 15.2156 ± 3.88135 pg mL(-1) respectively. Serum level of kisspeptin had significant differences between three groups (p < 0.001). Acute prepubertal immobilization stress led to decrease in serum level of kisspeptin and testosterone in stress (test) group compared to control groups. Also stress caused a significant decrease in the numbers of secondary spermatocytes of the test group.

Comparison of Specificity and Sensitivity of AMH and FSH in Diagnosis of Premature Ovarian Failure.

INTRODUCTION: Anti-Müllerian hormone represents the primitive follicular number and ovarian age. Low level of AMH is in relation to early menopausal state and decreased ovarian reserve. AMH level changes occur prior to FSH level in representing ovarian failure. The aim of this study is to compare sensitivity and specificity of AMH with FSH in diagnosis of POF. MATERIAL AND METHODS: This descriptive study is done on 96 patients referred to Dr. Rasekh Clinic. Serum level of AMH and FSH was measured at Day 3 (3rd day of menstrual cycle) and data were analyzed through SPSS 21 software. RESULTS: Results of AMH and FSH serum level indicate that AMH has more sensitivity (80% versus 28.57%) and almost equal specificity (78.89% versus 78.65%) compared with FSH. Also negative predictive value of AMH (98.61%) and FSH (87.5%) is different. But positive predictive value is the same (17.39%). Diagnostic accuracy of AMH is more than FSH and has significant differences. CONCLUSION: According to the results of this study, AMH serum level is more sensitive than FSH serum level. Also AMH has more negative predictive value. Besides, this hormone can be measured at any time of menstrual cycle, against FSH. AMH seems to be more useful in early diagnosis of POF.

Lack of Association Between rs17568 Polymorphism in OX40 Gene and Myocardial Infarction, Southern of Iran.

Tumor necrosis factor (TNF) is one of the inflammatory cytokines which has an important role in inflammation and migration of other inflammatory cells to the atherosclerotic plaques. OX40 is a member of the TNF super family receptor protein. OX40 and OX40 ligand are co-stimulators for T-cells and can increase inflammatory response in atherosclerotic plaques. The aim of this study was to determine the association of rs17568 polymorphism in OX40 gene with premature myocardial infarction. This case control study was done on 100 patients with premature acute myocardial infarction (AMI) and a similar number of sex, age and some other cardiovascular risk factor matched healthy people. The OX40 rs17568 polymorphism was genotyped, using PCR-RFLP method. A-allele frequency of rs17568 SNP was lower non-significantly in Premature AMI, compared to healthy subjects (49% vs. 51%). The analysis of rs17568 (A/G) polymorphism showed an odds ratio of 1.127 (95% CI: 0.635-1.999; P= 0.686) for the GG genotype and 5.761 (95% CI: 1.200-27.655; P= 0.029) for the AG genotype, compared to the AA genotype. The results of this study indicate that the rs17568 SNP of OX40 gene is not associated with premature AMI in the evaluated population.