Clinical efficacy of Fluorometholone versus Loteprednol eye drops after photorefractive keratectomy: A triple-blinded randomized controlled trial.

PURPOSE: This study aimed to compare the anti-inflammatory efficacy and safety of 0.1% Fluorometholone (FML) versus (vs.) 0.5% Loteprednol etabonate (LE) following photorefractive keratectomy (PRK). METHODS: A triple-blinded randomized controlled trial was conducted on both eyes of 100 patients with stable refraction who were candidates for PRK. Both eyes in each subject were randomly allocated to the FML or LE groups. The product to be tested was 0.1% FML eye drops packaged in droppers vs. the 0.5% LE sterile ophthalmic suspension (Lotemax®) packaged in identical droppers. The main clinical outcomes were changes in best-corrected distance visual acuity (BCDVA) and corneal optical density. The second clinical outcomes were a change in intraocular pressure (IOP) after the intervention. RESULTS: There was no significant difference regarding mean corneal optical density changes between the two groups, one (P = 0.55) and three months (P = 0.98) after the intervention. The mean ± SD BCDVA after one month of the intervention was 0.79 ± 0.11 and 0.84 ± 0.11 in LE and FML groups, retrospectively (P = 0.02). There was no significant difference regarding mean BCDVA between the two groups three months after intervention (P = 0.21). The IOP showed no significant difference between the two groups after one (P = 0.18) and three months (P = 0.53) of the intervention. CONCLUSIONS: The results of this clinical trial demonstrate that LE and FML treatment was effective with no clinically meaningful effect on IOP following a short course of treatment.

Concurrent presence of buccal mucosal and ophthalmologic lesions in Behcet's syndrome.

BACKGROUND: Behcet's syndrome is a disease with different aspects in its clinical manifestations. The purpose of this study was to evaluate the simultaneous presence of oral mucosal and ophthalmologic lesions in patients with Behcet's syndrome. METHODS: From April 2012 to December 2014, 50 cases of Behcet's syndrome who referred to the Departments of Ophtalmology, Oral Diseases and Infectious Diseases of Babol University Medical Sciences were entered into the study. The diagnosis of the disease was performed using the Iranian criteria for the diagnosis of Behcet's syndrome. The demographic findings as well as clinical manifestations were recorded. RESULTS: Thirt-six (72%) were males and 14 (28%) were females. The mean age of the patients was 35.6±9 years. Oral aphthous (94%), ocular lesion (76%) and genital ulcers (70%) were the most clinical findings. The clinical onset of the disease in 43 (86%) was oral lesions and in 5 (10%) was ocular lesions. Among the forty-eight cases with oral lesions, 77% had ocular lesions concurrently. HLA-B5 was positive in 35 (70%) cases. Ocular lesion was seen in 33 of 35 (91.4%) cases versus 6 of 15 (40%) with HLA-B5 positive and negative cases, respectively (p<0.05). Oral lesion was seen in 94.3% cases with positive HLA-B5 and in 100% cases with negative HLA-B5 (p>0.05). CONCLUSIONS: The results show that concurrent ophthalmic and oral lesions in Behcet's syndrome are relatively high. HLA-B5 positive cases are associated with more ophthalmologic lesions.

Cohort Profile Update: The Amirkola Health and Ageing Project (AHAP).

The original cohort study of AHAP started in 2011 on 1616 elderly residents of Amirkola, northern part of Iran near the Caspian Sea. The main goal of this study was to comprehensively evaluate the health of the elderly in the region with the emphasis on chronic diseases such as osteoporosis. The first cohort profile was published in the International Journal of Epidemiology in 2014. The phase 1 AHAP showed the elevated level of some diseases and conditions including osteoporosis, metabolic syndrome, obesity, vision problems and relatively low levels of oral health. Therefore, the second phase of this cohort started with more complete population coverage in 2016, not only to collect and record the information based on previous protocol, but also consider new areas such as nutritional status, complete eye and dental examinations and health assessment on the basis of Iranian Traditional Medicine. The new aspect of this project is to conduct clinical and laboratory examinations at the health center to extend more facilities to the elderly. In addition to serum and DNA, samples of saliva, hair and nails are collected and kept under standard conditions in the biobank of this cohort. Researchers can apply for access to data or suggest a collaborative study by submitting the proposal to AHAP committee.

Prevalence of age-related macular degeneration among the elderly.

BACKGROUND: Age-related macular degeneration (AMD) is the leading cause of visual impairment and blindness in elderly population in the developing countries. Previous epidemiological studies revealed various potential modifiable risk factors for this disease. The purpose of this study was to evaluate the prevalence of AMD among elderly living in Babol, North of Iran. METHODS: The study population of this cross-sectional study came from the Amirkola Health and Ageing Project (AHAP), the first comprehensive cohort study of the health of people aged 60 years and over in Amirkola, North of Iran. The prevalence of AMD was estimated and its risk was determined using logistic regression analysis (LRA) with regard to variables such as smoking, hyperlipidemia, hypertension and diabetes. RESULTS: Five hundred and five participants with mean age of 71.55±5.9 (ranged 60-89) years entered the study. The prevalence of AMD was 17.6%. There was a significant association between AMD and smoking (P<0.001) but no association was seen with AMD and age, level of education, history of hyperlipidemia, hypertension and diabetes. Multiple LRAs revealed that smoking increased AMD by odds ratio of 5.03 (95% confidence interval 2.47-10.23 p<0.001) as compared to nonsmokers. CONCLUSION: According to our findings, the prevalence of AMD was relatively high and smoking increased the risk of AMD in the elderly population.

Cohort profile: the Amirkola Health and Ageing Project (AHAP).

This is the first comprehensive cohort study of the health of older people ever conducted in Iran. The aim of this project is to investigate the health status of older people in Amirkola in the northern part of Iran, near the Caspian Sea. The Amirkola Health and Ageing Project (AHAP) is mainly concerned with geriatric medical problems, such as falling, bone fragility and fractures, cognitive impairment and dementia, poor mobility and functional dependence. It is planned that all participants will be re-examined after 2 years. Data are collected via questionnaire, examinations and venepuncture. AHAP started in April 2011 and 1616 participants had been seen by 18 July 2012, the end of the baseline stage of this study. The participation rate was 72.3%. The prevalence of self-reported hypertension (41.2%) and diabetes mellitus (23.3%) are high. Only 14.4% of older people considered their health as excellent or good in comparison with others at this age. The prevalence of osteoporosis (T score≤-2.5) was 57.4% in women and 16.1% in men, and 38.2 % of older people were vitamin D deficient (<20 ng/ml). Researchers interested in using the information are invited to contact the principal investigator Seyed Reza Hosseini (hosseinim46@yahoo.com).

Endonasal laser-assisted microscopic dacryocystorhinostomy: surgical technique and follow-up results.

PURPOSE: Endonasal dacryocystorhinostomy is known as an increasingly attractive and effective approach for the surgical treatment of nasal duct obstruction with minimal complications and best cosmetic consequences. In a relatively large-scale case-series study over a 5-year period, we describe the surgical technique and 12-month follow-up results of microscopic laser dacryocystorhinostomy with particular regard to the effect of various pre-/postoperational factors (ie, patients' sex, age, symptoms chronicity, previous interventions, duration of silicone intubation) on the surgical outcome. MATERIALS AND METHODS: A total of 162 cases in 151 patients with chronic epiphora, mucocele, or recurrent episodes of dacryocystitis were included in the study. Endonasal laser dacryocystorhinostomy was performed using a surgical microscope with transcanalicular lacrimal sac illumination. The laser types used were potassium-titanyl-phosphate and neodymium:yttrium-aluminum-garnet for ablation of nasal mucosa and application to bone, respectively. Patients were evaluated 6 months and 1 year later. Data were analyzed by chi(2) tests. RESULTS: There were no major complications during or after the operations. Complete cure occurred in 89.5% (after 6 months) and 74.2% (after 1 year) of the cases. Anatomical patency was shown by lacrimal system irrigation with fluorescein in 81.5% of the cases after the 12-month follow-up. It was found that patients younger than 55 years, with symptoms lasting less than 1 year, and without history of nasal problems, had significantly higher surgical success rates (P < .05). Moreover, rates of failure were significantly lower in cases whose canaliculi were intubated for 5 to 6 months (P < .05). CONCLUSIONS: Endonasal microscopic laser dacryocystorhinostomy is a safe and minimally invasive procedure with reasonable results. It has many advantages over external or other conventional approaches. Successful results could be further enhanced by more wisely selecting the patients and by silicone extubation after 6 months.

Simple excision alone versus simple excision plus mitomycin C in the treatment of pterygium.

BACKGROUND: Pterygium is a common ocular disorder throughout the world. The purpose of this study was to evaluate the efficacy of simple excision alone with or without topical mitomycin in the treatment of pterygium. PATIENTS AND METHODS: This study was performed in two stages. In the first stage, from 1991 to 1994, 100 patients (group 1) were operated on with simple excision and in the second stage, from 1995 to 1999, 300 patients (group 2) were treated with the same procedure plus topical mitomycin (0.02% eye drops four times a day for 4 days after operation). All cases were followed for 5 years. The recurrence rate of pterygium in these two treated groups were compared. RESULTS: The mean age of the subjects was 49+/-13 years in group 1 and 47+/-17 years in group 2. The clinical manifestations in these two groups were similar (P>0.05). After one year, relapse was seen in 21 cases (21%) in group 1 and in 3 cases (1%) in group 2. After five years, 31 cases (31%) in group 1 and 3 cases (1%) in group 2 had relapse (P=0.0001). The mean time to recurrence at five years for the simple excision group was 3.83 years (95% CI: 3.48 to 4.17 years) and for simple excision plus mitomycin C was 4.96 years (95% CI: 4.91 to 5.0 years) (P<0.0001). CONCLUSION: Instillation of mitomycin C eye drops appears to be safe in the treatment of pterygium.