Topical insulin for refractory persistent corneal epithelial defects.

The aim was clinical evaluation of the efficacy of topical insulin eye drops in patients with refractory persistent epithelial defects (PEDs). This prospective non-randomized investigation was conducted to examine the efficacy of insulin eye drops in treating patients with PEDs that did not respond to conventional therapy. A total of twenty-three patients were included in the study, and they were administered insulin eye drops formulated as 1 U/mL, four times a day. The rate of epithelial defect resolution and time to complete corneal re-epithelialization were considered primary outcome measures. The relative prognostic impact of initial wound size and other parameters, including age, sex, smoking, diabetes, and hypertension were also analyzed. The results showed that during follow-up (maximum 50 days), a total of 16 patients (69.6%) achieved improvement. Insulin eye drops significantly reduced the corneal wounding area in 75% of patients with small epithelial defects (5.5 mm2 or less) during 20 days. Only 61% of patients with moderate epithelial defects (5.51-16 mm2) showed a significant recovery in 20-30 days. Also, 71% of patients with a defect size greater than 16 mm2, demonstrated a significant improvement in the rate of corneal epithelial wound healing in about 50 days. In conclusion topical insulin reduces the PED area and accelerates the ocular surface epithelium wound healing.

The development and validation of a standardised eight-station OSCE for registration of undergraduate nursing students: A Delphi study.

AIM: To develop and validate a set of OSCEs for use as a nationally applicable final exam of undergraduate nursing students' clinical and professional competencies. BACKGROUND: Tertiary recommendations for nursing registration require student achievement of a prerequisite level of both nursing knowledge and skill. Assessment of nursing skills prior to provision of nursing registration is an increasingly important focus of university nursing education. Objective Structured Clinical Examinations (OSCEs) are an appropriate tool for assessing the competencies of nursing students, but the mode and content of OSCEs varies widely. Thus, for nationally-based registration, development of a standardized set of OSCEs to determine the clinical competence of nursing students is important. DESIGN: A modified Delphi study, informed by a systematic scoping review of relevant literature. METHODS: A two-phase study was conducted. Initially, a scoping review was conducted to establish internationally agreed competences for graduating nursing students. These were included in an online questionnaire send to national experts to develop a validated and accepted nursing competency framework and associated implementation strategies. This was round 1 of a three-round modified Delphi study. A Content Validity Index (CVI) was calculated and thematic analysis was used to analyze the experts' opinions. RESULTS: Details of a set of OSCEs for final exam of undergraduate nursing students were developed and validated. These OSCEs included nine competencies addressed in eight 10-minute stations. CONCLUSION: A 'best-practice' OSCE evaluation system, designed from both international literature and the opinions of nation-wide experts was achieved. This well-designed OSCE was shown to be a reliable and valid method for assessing the clinical competence of nursing students. It reflected global procedures as well as the local conditions and Iranian expectations. The results of this study can be used by nursing schools across the country. They can also be used to model equivalent development of locally relevant OSCEs in countries around the world.

Mapping of Iranian midwifery curriculum according to the International Confederation of midwives competencies.

BACKGROUND: Evaluating the curriculum based on its success rate in preparing skilled midwives proficient in performing professional skills is a fundamental component of the midwifery education system. This study aimed to evaluate the content, strengths, and weaknesses of the midwifery curriculum in Iran based on the most recent ICM midwifery education standards in all competence areas, as well as to obtain expert feedback on the necessary courses or lessons for the curriculum using the Delphi method. METHODS: This research was conducted in two phases: comparative analysis and the Delphi method. In the comparative analysis, the curriculum mapping tool was used to compare Iran's midwifery curriculum for bachelor's degrees to the international standards for midwifery education proposed by ICM in 2019 by a four-point Likert scale (adequate- relatively adequate- relatively inadequate- inadequate). Two individuals evaluated the curriculum independently for the presence of theoretical and clinical courses for attaining each relevant competency. In case of disagreement, the opinion of a third person was used. After identifying the academic deficiencies and weaknesses of the curriculum, the Delphi technique was used with the cooperation of the midwifery board members and directors of midwifery groups from across the country to collect feedback about new courses or lessons that need to be incorporated into the curriculum. RESULTS: After a comparative analysis, 24 out of 315 essential competencies for ICM in the midwifery curriculum were found to be inadequate or relatively inadequate based on the three experts' opinions after reviewing the programmatic courses and lessons in the curriculum. In 79.5% of the knowledge area and 71.6% of the skill area, the curriculum for midwifery in Iran corresponded to ICM essential competencies. After surveying expert members during multiple Delphi rounds, the members agreed to add some lessons to the midwifery curriculum, design a new course, and hold related workshops to cover the competencies identified as inadequate or relatively inadequate in the comparative analysis. CONCLUSION: The Iranian midwifery curriculum for acquiring 24 items of ICM essential competencies was deemed inadequate or relatively inadequate. Therefore, it seems in addition to revising Iran's midwifery curriculum following ICM competencies, providing midwifery policymakers with infrastructure and additional support to develop and implement effective midwifery training programs is necessary to ensure that midwives are trained and equipped with the necessary competencies for practice.

Fungal Infection After Descemet Membrane Endothelial Keratoplasty: Incidence and Outcomes.

PURPOSE: The aim of the study was to describe the incidence, presentation, management, and outcomes of fungal infection after Descemet membrane endothelial keratoplasty (DMEK). METHODS: Retrospective case series of culture-proven fungal infections after DMEK reported in the literature, directly by surgeons, and to the Eye Bank Association of America from January 1, 2011, to December 31, 2020. RESULTS: The domestic incidence of fungal infections, fungal keratitis, and fungal endophthalmitis after DMEK from 2011 to 2020 was 3.5, 1.3, and 2.2 per 10,000 cases, respectively, with no significant increasing trend. Thirty-four cases were identified, 14 (41.2%) published and 20 (58.8%) unpublished. Donor tissue fungal cultures were performed in 20 of the 34 (58.8%) cases and were positive in 19 of the 20 (95.0%), all but one Candida species. Recipient fungal cultures were performed in 29 of the 34 (85.3%) cases and were positive in 26 of the 29 (89.7%), all but one Candida species. Infection presented a mean of 33 ± 38 days (median 23, range 2-200, outlier 949) after transplantation: 25 (73.5%) with endophthalmitis and 9 (26.5%) with keratitis. Topical, intrastromal, intracameral, intravitreal, or systemic antifungal therapy was used in all 27 eyes with treatment data. Surgical intervention (DMEK explantation or partial removal, repeat endothelial keratoplasty, penetrating keratoplasty, and/or pars plana vitrectomy) was required in 21 of the 27 (77.8%) eyes. The corrected distance visual acuity at the last follow-up was ≥20/40 in 13 of the 27 (48.1%) eyes and counting fingers or worse in 6 of the 27 (22.2%) eyes. CONCLUSIONS: Fungal infection is a rare but serious complication of DMEK that results in counting fingers or worse corrected distance visual acuity in nearly a quarter of eyes.

Microbiological study on foreign body and vitreous samples of patients with intraocular foreign body.

OBJECTIVE: To evaluate the relationship between the microbiological results of the vitreous humor and those of foreign body specimens in patients with intraocular foreign body (IOFB). METHODS: Seventy-one patients with an IOFB were included in this descriptive prospective case series. All patients underwent immediate IOFB removal. Vitreous sampling was performed during vitrectomy. Foreign bodies were placed directly into culture media for microbiological study. RESULTS: Thirteen (18.3%) patients developed endophthalmitis. The results of microbiological analysis of IOFB and vitreous humor specimens were negative in nine patients and positive in four. Fifty-eight (81.6%) patients with an IOFB had no evidence of endophthalmitis. Among them, seven patients showed positive microbiological results of foreign bodies with no manifestations of endophthalmitis. In five patients, a Staphylococcus epidermidis strain was observed in the culture of the IOFB specimen. Two patients had only positive smear test results of their vitreous humor specimen. CONCLUSION: A correlation appears to be present between the microbiological results of the vitreous humor and IOFB specimens in patients with clinical findings of endophthalmitis but not in patients with a pure IOFB without clinical features of endophthalmitis. This may justify early use of intravitreal and intravenous antibiotics before the development of endophthalmitis.

Preparation and characterization of TiO2-coated polymerization of methyl methacrylate (PMMA) for biomedical applications: In vitro study.

Low surface energy and hydrophobicity of polymethyl methactylate (PMMA) are the main disadvantages of this biomaterial. The aim of this study was to investigate the effects of a new coating process on the surface characteristics and properties of PMMA. A combination of temperature and pressure was used for deposition of titanium dioxide (TiO2) on the surface of PMMA. The PMMA coated with TiO2 thin films and prepared by sputtering and non-coated PMMA were considered as control groups. The surface wettability, functional group, and roughness were determined by contact angle measurement, Fourier transform Infrared spectroscopy (FTIR), and 3D laser scanning digital microscopy, respectively. The flexural strength of coated and non-coated samples was measured using three-point bending test. The cell proliferation, attachment, and viability were determined using 3-(4,5-dimethyldiazol-2-yl)-2,5-diphenyl tetrazolium bromide, live and dead assay, scanning electron microscope (SEM), and DAPI (4',6-diamidino-2-phenylindole) staining. The antifungal activity of TiO2 was also determined by examining the biofilm attachment of Candida albicans. The obtained results showed that TiO2 was successfully coated on PMMA. The contact angle measurement shows a significant increase of hydrophilicity in TiO2-coated PMMA. FTIR and roughness analysis revealed no loss of TiO2 from coated specimens following sonication. The cell viability after 7 days culturing on TiO2-coated specimens was more than the cell viability on the control groups. SEM images and DAPI staining showed that the total number of the cells increased after 7 days of seeding on TiO2-coated group, whereas it decreased gradually in both control groups. C. albicans attachment also decreased by 63% to 77% on the coated PMMA surface. Overall, this research suggested a new way for developing surface energy of PMMAs for biomedical applications.

Ray Tracing versus Thin-Lens Formulas for IOL Power Calculation Using Swept-Source Optical Coherence Tomography Biometry.

Purpose: To evaluate the ray tracing method's accuracy employing Okulix ray tracing software and thin-lens formulas to calculate intraocular lens (IOL) power using a swept-source optical coherence tomography (SS-OCT) biometer (OA2000). Methods: A total of 188 eyes from 180 patients were included in this study. An OA-2000 optical biometer was used to collect biometric data. The predicted postoperative refraction based on thin-lens formulas including SRK/T, Hoffer Q, Holladay 1, and Haigis formulas and the ray tracing method utilizing the OKULIX software was determined for each patient. To compare the accuracy of approaches, the prediction error and the absolute prediction error were determined. Results: The mean axial length (AL) was 23.66 mm (range: 19-35). In subgroup analysis based on AL, in all ranges of ALs the ray tracing method had the lowest mean absolute error (0.56), the lowest standard deviation (SD; 0.55), and the greatest proportion of patients within 1 diopter of predicted refraction (87.43%) and the lowest absolute prediction error compared to the other formulas (except to SRK/T) in the AL range between 22 and 24 mm (all P < 0.05). In addition, the OKULIX and Haigis formulas had the least variance (variability) in the prediction error in different ranges of AL. Conclusion: The ray tracing method had the lowest mean absolute error, the lowest standard deviation, and the greatest proportion of patients within 1 diopter of predicted refraction. So, the OKULIX software in combination with SS-OCT biometry (OA2000) performed on par with the third-generation and Haigis formulas, notwithstanding the potential for increased accuracy in the normal range and more consistent results in different ranges of AL.

Idiopathic Vitritis after Boston Type 1 Keratoprosthesis Implantation: Incidence, Risk Factors and Outcomes in a Multicentric Cohort.

PURPOSE: To determine incidence, risks factors for, and outcomes of idiopathic vitritis (IV) after Boston type 1 keratoprosthesis (KPro) implantation. METHODS: Retrospective, consecutive case series. Risk factors were analyzed between IV group and No IV group. RESULTS: IV occurred in 32/350 procedures (9.1%), for an average incidence of 0.02 cases per procedure-year. Presumed infectious keratitis was the only risk factor identified (HR = 7.65) Corneal necrosis and retinal detachment occurred significantly more frequently in IV group (all P < .05). By last follow-up, the cumulative proportion of eyes that maintained a visual acuity >20/200 was significantly lower in IV group (P = .01), as was the KPro retention rate (HR = 0.26). CONCLUSIONS: IV is associated with infectious keratitis, indicating that the vitritis may not be a sterile process. The increased incidence of subsequent complications leads to significantly decreased visual acuity and KPro retention in affected eyes.

Recombinant Interferon Alpha-2b as Primary Treatment for Ocular Surface Squamous Neoplasia.

PURPOSE: To investigate the effects of topical and perilesional interferon alpha-2b as primary treatment for ocular surface squamous neoplasia (OSSN). METHODS: In this prospective interventional case series, topical interferon alpha-2b (3 MIU/mL) was used as the initial treatment of OSSN, with perilesional interferon alpha-2b (3 MIU/mL) added based on clinical response. The primary outcome was complete tumor resolution. Spearman's rank correlation test was used to investigate the association of complete tumor resolution and time to resolution with baseline tumor characteristics and the American Joint Committee on Cancer (AJCC) classification for OSSN. RESULTS: Ninety-two patients (92 OSSN tumors) were included in the study. The total follow-up duration was 13.57 ± 2.14 months (median: 12, range: 3-23). The median basal tumor diameter was 4 mm (mean: 4.13 ± 1.37). Complete tumor resolution was achieved in 89 cases (96.73%), with a median time to complete tumor resolution of 5 months (mean: 4.64 ± 1.92). Complete tumor resolution was 57 of 57 in T1 (100%), 8 of 9 in T2 (88.88%), and 21 of 23 in T3 (91.30%). There were statistically significant correlations between AJCC classification and complete tumor resolution (Spearman's r = -0.22, P = 0.03) and maximal basal tumor diameter and the time to complete resolution (Spearman's r = 0.35, P = 0.001). There were no recurrences during the study follow-up period. CONCLUSION: Topical interferon alpha-2b is effective and well tolerated as a primary treatment for OSSN, with a high rate of tumors responding completely to therapy.

In vivo Confocal Microscopic Evaluation of Corneal Changes in Acute Endothelial Rejection.

PURPOSE: To evaluate the microstructural corneal changes during acute endothelial graft rejection and following treatment using in vivo confocal microscopy (IVCM). METHODS: Patients with a clinical diagnosis of severe acute endothelial graft rejection following penetrating keratoplasty were included in this study. IVCM was performed on the 1st day the patient presented with rejection signs and at the time of clinical resolution. RESULTS: Twenty-three patients were included in this study. Inflammatory cells appeared as dendritic cells (DCs) and less frequently, as non-DCs in basal epithelial and subbasal areas. Activated keratocytes (AKs) (type 1: large cells with visible cytoplasmic processes; type 2: elongated and spindle-shaped keratocytes) were visible in acute phase. Following resolution, type 1 AKs considerably reduced, but type 2 cells were more often persisted. Multiple types of keratic precipitates (KPs) were also visible in acute phase which resolved following resolution of rejection. CONCLUSIONS: Acute graft rejection was associated with an increase in the number of DCs, activation of keratocytes, and aggregation of various types of KPs. Inflammatory process subsided in almost all cases, but the IVCM changes did not return to normal early after clinical resolution of rejection.

Challenges of objective structured clinical examination in undergraduate nursing curriculum: Experiences of faculties and students.

BACKGROUND: Assessment of clinical competence of nursing students is necessary to ensure safe practice and the realization of professional clinical standards. An Objective Structured Clinical Examination (OSCE) is commonly used internationally in nursing education programs to assess clinical competence, but is a new process in Iranian nursing curricula. OBJECTIVE: The aim of this study was to explore and describe challenges associated with OSCE implementation based on the experiences of faculty members and nursing students, with the objective of further improving the assessment of clinical competence in nursing education. DESIGN: This study used a qualitative approach that included thematic analysis of the transcribed interviews. SETTING: Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences (TBZMED), Tabriz, Iran. PARTICIPANTS: Purposive sampling was used to select eighteen faculty members and fifteen students from those interested. These participants represent a reasonable cross-section of those who had participated in the OSCE. METHODS: A pre-developed interview guide was used to inform semi-structured in-depth interviews. These were recorded and analyzed using the 6-phase thematic analysis method as described by Braun and Clarke (2013). Themes were independently verified. RESULTS: Challenges identified by participants around OSCEs as part of undergraduate nursing education were extracted from the interview data. Two main themes were evident from the data: 1) shortcomings in executive and technical infrastructure, 2) shortcomings in educational infrastructure. These themes reflected both student and faculty experiences. These also aligned with themes that commonly emerge in related literature. CONCLUSION: The study findings illustrate several key challenges associated with organizing and implementing OSCEs and so provides unique insights into the development of strategies to implementing and promoting OSCEs in nursing education. We recommend that managers and authorities in nursing education focus on these challenges and explore processes to successfully introduce this exam for assessment of nursing student capacity.

Infectious Keratitis After Boston Type 1 Keratoprosthesis Implantation.

PURPOSE: To identify the incidence, risk factors, and outcomes of infectious keratitis after Boston type 1 keratoprosthesis (kpro) implantation. METHODS: Retrospective case series of kpro procedures at the Stein Eye Institute and the Centre Hospitalier de l'Université de Montréal between May 1, 2004, and December 31, 2018. Data were collected regarding ocular history, operative details, postoperative management, microbiologic profile, treatment, and outcomes. Log-rank test and Cox proportional hazard ratio (HR) were used to evaluate for an association between risk factors and outcomes. RESULTS: A total of 349 kpro procedures were performed in 295 eyes of 268 patients. Fifty-seven cases of presumed infectious keratitis were identified after 53 procedures (15.2%) in 50 eyes (16.9%) of 49 patients (18.3%). The incidences of culture-positive bacterial and fungal keratitis were 0.014 and 0.004 per eye-year, respectively. Persistent corneal epithelial defect formation (P < 0.001) and cicatricial disease (HR: 1.98, 95% confidence interval, 1.02-3.83) were associated with a significantly higher incidence of infectious keratitis. For the 53 cases with a known outcome, medical therapy achieved resolution of infection in 34 cases (64.2%), whereas kpro explantation was required in 19 cases (35.8%). Infectious keratitis was associated with an increased risk for kpro explantation (HR: 3.09, 95% confidence interval, 1.92-4.79). CONCLUSIONS: Infectious keratitis develops in approximately 17% of eyes after kpro implantation, with a higher rate of culture-positive bacterial than fungal keratitis. The observed rate of microbial keratitis suggests the need for additional topical antimicrobial prophylaxis in eyes at higher risk, such as those with preexisting cicatricial disease or postoperative persistent corneal epithelial defect formation.

Complications of Cosmetic Artificial Iris Implantation and Post Explantation Outcomes.

PURPOSE: To report complications of cosmetic artificial iris implantation and explantation outcomes. DESIGN: Retrospective case series. METHODS: Medical records of 12 patients (24 eyes) who presented to us after being implanted with cosmetic artificial irises elsewhere were reviewed. Data collected included baseline demographics, presenting symptoms, examination findings, and management outcomes. RESULTS: Eight eyes had NewColorIris implants and 16 had BrightOcular implants. The mean interval from cosmetic iris implantation to presentation was 61.7 ± 60.0 months. The mean follow-up after explantation was 35.5 ± 38.1 months. Complications at presentation included iris abnormalities (11 eyes, 45.8%), elevated intraocular pressure (8 eyes, 33.3%), corneal edema (6 eyes, 25%), intraocular inflammation (5 eyes, 20.8%), and cataract (4 eyes, 16.7%). Surgical interventions included cosmetic iris removal (19 eyes, 79.2%), cataract extraction (7 eyes, 29.2%), corneal transplantation (7 eyes, 29.2%), and glaucoma surgery (4 eyes, 16.7%). Complications at the last follow-up examination included native iris defects (11 eyes, 45.8%), persistent glaucoma (7 eyes, 29.2%), cataract (5 eyes, 20.8%), corneal edema (4 eyes, 16.7%), and intraocular inflammation (2 eyes, 8.3%). The mean logarithm of the minimum angle of resolution was 0.56 ± 0.47 at presentation and 0.78 ± 0.88 at the last examination (P = .30). The mean intraocular pressure was 22.7 ± 15.8 mm Hg at presentation and 13.4 ± 6.99 mm Hg at the last examination (P = .02). CONCLUSION: Cosmetic iris implantation was associated with serious complications at the time of presentation, and adverse sequelae persisted for years after explantation.

Changes in Corneal Subbasal Nerves after Punctal Occlusion in Dry Eye Disease.

PURPOSE: To evaluate corneal subbasal nerve plexus by in vivo confocal microscopy (IVCM) following punctal occlusion in patients with moderate to severe dry eye disease (DED). MATERIALS AND METHODS: Patients with grade 3 or 4 severity of DED based on Delphi Panel dry eye severity grading scheme were enrolled in the study. Permanent inferior punctal occlusion was performed. A comprehensive ophthalmic evaluation, including Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), corneal fluorescein staining, conjunctival Rose bengal staining, Schirmer's test, and corneal sensation by Cochet-Bonnet esthesiometry, were performed at baseline, and 1 and 3 months after punctal occlusion. Furthermore, density and number of corneal subbasal nerves were evaluated by IVCM. RESULTS: Forty-one eyes of 23 patients with a mean age of 46.3 ± 9.0 years were enrolled. Corneal fluorescein staining, Rose bengal staining, and TBUT significantly improved at 3 months following punctal occlusion (p < .015). Corneal esthesiometry significantly increased at both postoperative visits (p < .03), and OSDI scores improved only at 3-month follow-up (p < .005). Nerve density and total number significantly increased 3 months after punctal occlusion (p < .045). Baseline nerve density had significant correlations with TBUT, fluorescein staining, Rose bengal staining (p < .012), but not with esthesiometry, Schirmer scores, or OSDI scores (p > .329). CONCLUSIONS: Corneal subbasal nerve density and total number increased following punctal occlusion in patients with moderate to severe DED. These findings were associated with improvements in corneal sensation, and signs and symptoms of DED. This emphasizes the effect of punctal occlusion in regeneration of corneal subbasal nerve plexus.

Accountability in medical education from theory to practice Tabriz 2018 statement: A step towards the implementation of this social necessity.

Background: To implement the education reform package on accountability in medical education, the Education Development Center (EDC) of Tabriz University of Medical Sciences has held the first national conference on accountability in medical education, and the present statement is the result of scientific interactions and exchanges in the conference. Methods: For implementation of the accountability in medical education, there was a need to inform faculty members and other stakeholders about their responsibility in education and health care needs. The provision of such platform was provided by holding a specialized conference on accountability in medical education by Tabriz University of Medical Sciences. Steps of preparing the draft version of the Tabriz 2018 Statement were as follow: Formation the scientific committee; Division of the responsibility for drafting the statement between various workgroups; and Preparation and primary approval of the draft of Tabriz 2018 Statement. Results: Steps of preparing the draft version of the Tabriz 2018 Statement were: Formation of the scientific committee, Division of the responsibility for drafting the statement between the various workgroups and Preparation and primary approval of the draft of Tabriz 2018 Statement. Conclusion: Establishing an educational accreditation model and reviewing accreditation standards based on social accountability can be an effective step to strengthen accountability towards community needs.

Development and Psychometric Analysis of the Measure of Perceived Adherence to the Principles of Medical Ethics in Clinical Educational Settings: Trainee Version (PAMETHIC-CLIN-T).

OBJECTIVE: This study was conducted to develop and assess psychometric properties of the "Measure of Perceived Adherence to the Principles of Medical Ethics in Clinical Educational Settings: trainee version (PAMETHIC-CLIN-T)" as a data collection tool to enhance research performance rigor in future medical ethics studies. PATIENTS AND METHODS: A multi-tiered six stage procedure was applied to develop the PAMETHIC-CLIN-T and assess its psychometric properties in a sample of Iranian medical science undergraduate students (n=263). The final constructed item pool contained 16 questions with the response options in five Likert-type categories. The higher total score indicated better compliance with the ethics and professional conduct regulations. Internal consistency reliability was examined and exploratory factor analysis (EFA) with direct oblimin rotation and principal components analysis (PCA) were carried out to reduce the overall constructed items into latent factors based on commonalities within the data set. FINDINGS: Factor analysis results revealed a 4-factor solution. All 16 items had factor loading greater than absolute value of 0.3 that accounted for 60.57% of the variance. The value of Kaiser Meyer Olkin (KMO) measure of sampling adequacy for factor analysis (0.909) and also Bartlett's test of sphericity (X2=1630.63, df=120, P-value<0.001) approved interpretability of the EFA output. CONCLUSION: Feasibility testing and psychometric analysis of the constructed scale yielded research evidence to support a four-factor model to be applied in future studies about the extent of perceived adherence to the principles of medical ethics in clinical educational settings.

Long-Term Outcomes of Descemet Membrane Endothelial Keratoplasty in Eyes with Prior Glaucoma Surgery.

PURPOSE: The purpose of this study was to evaluate the long-term outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes that had previously undergone trabeculectomy and/or drainage device implantation. DESIGN: Retrospective, noncomparative case series. METHODS: Medical records of 251 consecutive DMEK procedures performed by 1 surgeon (S.X.D.) from 2013 to 2017 were reviewed. Patients with ≥2 years of follow-up were divided into 3 groups: eyes with prior glaucoma surgery (ST), eyes with medically treated glaucoma (MT), and eyes without glaucoma (NG). Main outcomes measured were visual acuity, endothelial cell count (ECC), rates of secondary graft failure (SGF), and postoperative complications. RESULTS: Ninety procedures (87 eyes) met inclusion criteria. The mean follow-up period of all eyes was 38.4 ± 11.2 months (range, 24.2-64.4 months). At last follow-up, the proportion of eyes reaching a vision of ≥20/40 was higher than that before the DMEK procedure in each group (all P < .05). The rate of ECC loss was the highest in the ST group compared to that in the MT and NG groups (63.8% vs 47.6% vs 44.0%, respectively; P < .05) as well as the rate of SGF (41.6% vs 0% vs 2.4%, respectively; P < .05). The rate of SGF of repeat DMEK was higher than that of primary DMEK (P < .05). The rates of postoperative complications were similar among all groups (all P > .05). CONCLUSIONS: In eyes with prior glaucoma surgery, DMEK achieved good long-term visual outcomes but experienced a higher rate of SGF than eyes without such comorbidity.

Assessing the Validity of Measurements of Swept-source and Partial Coherence Interferometry Devices in Cataract Patients.

SIGNIFICANCE: The validity of measurements of OA-2000 (Tomey, Nagoya, Japan), a new swept-source optical coherence tomography-based biometer, was evaluated in comparison with IOLMaster 500 (Carl Zeiss Meditec AG, Jena, Germany) as a reference method for optical biometry in cataract patients. PURPOSE: This article compares the validity of measurements between OA-2000 and IOLMaster 500. METHODS: In this cross-sectional study, axial length, lens thickness, anterior chamber depth, and keratometry readings were obtained by the OA-2000 and IOLMaster 500. Two measurements were taken by each method. Patients in which any one of the biometry methods could not be performed owing to severity of the cataract were excluded from the study. Repeatability of measurements was presented by coefficient of variation, and Bland-Altman method was used for evaluating the agreement between the two biometers. RESULTS: Fifty-eight eyes of 58 cataract patients with mean ± standard deviation age of 61.4 ± 8.3 years were included in this study. Intraclass correlation ranged from 0.898 to 0.901 and showed good to excellent reliability. It was good for keratometry 1 (0.898) and excellent for keratometry 2 (0.992), axial length (0.999), and anterior chamber depth (0.901). Bland-Altman analysis showed good agreement between the swept-source optical coherence tomography and partial coherence interferometry devices for axial length, anterior chamber depth, and mean keratometry, with narrow 95% limits of agreement (-0.09 to 0.1 mm, -0.33 to 0.54 mm, -0.97 to 1.03 D, respectively), and also indicated small mean difference (0.01 for axial length, 0.11 for anterior chamber depth, 0.03 for mean keratometry, respectively) for all comparisons. CONCLUSIONS: OA-2000 as a new swept-source optical coherence tomography has an excellent repeatability for measurement of biometric data in cataract patients, comparing with the standard partial coherence interferometry biometer (IOLMaster 500).

Comparison of General Dentistry Curriculum in Iran with Eight of the World's Top Dental Faculties.

Background and objectives:A curriculum is a general and immense outline of an educational activity. A curriculum defines teaching content, student and curriculum assessment methods, and ultimately defines the framework for each activity in the curriculum. Given the importance of training in medicine and dentistry, the purpose of this study was to compare Iran's general dentistry curriculum with eight of the world's top dental faculties. Materials and methods:In descriptive-comparative research, the important components and parameters of the curriculum of the PhD in dentistry at several universities in the world were studied and compared with Iranian curriculum. The present study was conducted in two stages: The first phase included finding the best dental faculties in the world; the second phase was to identify and examine the various components of the curriculum of the PhD in Public Dentistry in Iran and the 8th highest dental faculties in the world and compare them according to Loudvigsson indicators. The results of the study were reported using descriptive statistics (frequency and percentage). Results:All of the evaluated indicators were in the Iranian curriculum. The study of the eight top universities in the world showed that the indicators worth paying attention to, including critical thinking and scientific approach in the program, student-centered curriculum, horizontal and vertical integration, systematic education, education based on community health care system, community-based education and ethical principles, existed in all curricula of the studied colleges. The presence of a selective framework in a curriculum and early clinical exposure was only available in the educational curriculum of four universities: Toronto, UNC, Minnesota and UCLA. The focus on small group work was defined as the prevailing educational method in three Herman Ostrow, Minnesota and UCSF universities. The problem-solving learning index was only presented at two universities in Osaka and NYU. Conclusion:The highest rates of Loudvigsson indicators in general dentistry curriculums of eight universities in the world were 90% and at least 72.7%, while the above indicators were 100% in the dentistry curriculum of Iran. According to the indicators of Loudvigsson, Iran's dental training program is ranked high in content.

Two-year changes in corneal stiffness parameters after accelerated corneal cross-linking.

The objective of this non-randomized trial was comparison of two-year changes in dynamic corneal response (DCR) between 18 mW/cm2 (5- min) and 9 mW/cm2 (10-min) cross-linking (CXL) protocols, using novel stiffness parameters and correlating them to clinical indices. The two groups were evaluated before and 2 years after the procedure using Corvis ST (Oculus Optikgeräte GmbH, Germany) and DCR parameters such as deformation amplitude ratio at 1 mm and 2 mm (DA ratio-1 mm and DA ratio-2 mm) and integrated radius and stiffness parameters at A1 (SP-A1). Two-year follow-up was completed for 16 of the 30 eyes in the 5-min group and 21 of the 25 eyes in the 10-min group; data from those who were lost to follow-up was not included in the analyses. Mean age at baseline was 21.7 ±â€¯4.9 and 21.5 ±â€¯5.2 years in the 5- and 10-min groups, respectively (P = 0.895). At 2 years after CXL, in the 5-min group, the reduction in integrated radius (-1.12 ±â€¯1.27 mm, P = 0.003) was significant, and the increase in SP-A1 (7.11 ±â€¯14.86 mmHg/mm, P = 0.075) was borderline, while in the 10-min group, the decrease in DA ratio-2 mm (-0.43 ±â€¯0.58, P = 0.003) and integrated radius (-1.89 ±â€¯1.72 mm, P < 0.001), and increase in SP-A1 (7.67 ±â€¯10.92 mmHg/mm, P = 0.004) were significant. In both groups, the strongest and significant correlation was observed between DCR parameters and changes in radius of curvature. In conclusion, results indicated corneal strengthening with both protocols especially with the 9 mW/cm2. Corvis ST indices can provide "in vivo" biomechanical evidence on the efficacy of CXL that may occur prior to clinical indices.