Impact of first eye cataract surgery on falls among patients of advanced age: a comparative study.

OBJECTIVE: To compare the incidence of falls between patients with visually significant cataracts in both eyes and those who have undergone first-eye cataract surgery. METHODS: This retrospective case-control study involved patients with a history of cataracts in both eyes who had undergone first-eye cataract surgery within the past 9 to 12 months (pseudophakic group). The control group comprised patients with cataracts in both eyes (cataract group). We assessed best-corrected visual acuity (BCVA), systemic comorbidities and medications (using the Charlson comorbidity index), and independent daily activities (using the Lawton Instrumental Activities of Daily Living scale). The patients were questioned about experiencing two or more falls in the last 6 months. RESULTS: Each group comprised 50 patients. Binocular BCVA was significantly better in the pseudophakic group (0.05 ± 0.06 logMAR) than in the cataract group (0.77 ± 0.34 logMAR). Of all participants, 22% reported experiencing two or more falls in the last 6 months. Multivariate analysis demonstrated significantly better BCVA in participants with less than two falls. CONCLUSIONS: Patients of advanced age with visually significant cataracts in both eyes are at a higher risk of falling. First-eye cataract surgery may mitigate the occurrence of falls by improving binocular BCVA.

Retinal and choroidal microvasculature in early and three months post COVID-19: A case-control study.

To compare the retinal vascular density (VD), choroidal vascularity index (CVI), and choroidal thickness (CHT) between patients infected with COVID-19 and healthy subjects using non-invasive optical coherence tomography angiography (OCTA) and enhanced depth imaging OCT (EDI-OCT) technique. This case-control study was carried out on patients with COVID-19 and healthy controls. Patients' data were acquired immediately after active infection and three months later. The diagnosis was based on clinical symptoms and a positive PCR test. VDs in superficial and deep capillary plexuses (SCP and DCP) and CHT and CVI were measured and compared between groups. A total of 160 eyes from 80 patients (55% female, mean age 51 ± 13 years) and 80 controls (55% female, mean age 49 ± 12 years) were enrolled. In acute phase infection, the mean foveal avascular zone (FAZ) area was 0.28 ± 0.06 mm2 and 0.22 ± 0.05 mm2 in patient and control groups, respectively (P < 0.001). CVI was 61.06 ± 2.59 µm and 72.28 ± 3.84 µm in patients and control groups, respectively (P < 0.001). After three months, the mean FAZ area was 0.28 ± 0.06 mm2 and 0.23 ± 0.05 mm2 in the patient and control groups, respectively (P < 0.001). CVI was 60.93 ± 2.11 µm and 72.46 ± 3.80 µm in patients and control groups, respectively (P < 0.001). Subfoveal CHT was not significantly different between groups (P = 0.69). SCP and DCP VDs were significantly less in the patients' group (P < 0.001). In the patients' group, the VDs in the DCP of the whole images and parafoveal DCP (P < 0.001) were reduced significantly after three months in comparison to the acute phase, while the FAZ area, subfoveal CHT, and CVI were not significantly different. COVID-19 infection may be associated with acute and long-term changes of VDs in the retinal and choroidal vasculature without significant effect on the subfoveal CHT.

Combined phacoviscocanalostomy versus phacoemulsification alone in patients with coexisting cataract and mild-to-moderate open-angle glaucoma; a randomized-controlled trial.

BACKGROUND/OBJECTIVE: Management of concomitant cataract and glaucoma depends on the stage of glaucoma and the patient's situation. There are different surgical options for handling visually significant cataract and mild-to-moderate open-angle glaucoma (OAG). We aimed to compare the one-year results of phacoemulsification alone versus phacoviscocanalostomy in these patients. SUBJECTS/METHODS: This was a parallel-arm, single-masked, randomized-controlled trial, conducted at Farabi Eye Hospital, Tehran, Iran between January 2016 and January 2018. We enrolled 89 eyes from 89 patients with mild-to-moderate primary OAG or pseudoexfoliative glaucoma (PEXG) with visually significant age-related cataract. They randomly underwent phacoemulsification alone (n = 44) or combined phaco-viscocanalostomy (n = 45). All patients had a 12-month follow-up period, and the mean intraocular pressure (IOP), the number of antiglaucoma medications, and complete and qualified success rates were compared. RESULTS: After the 1st and 3rd months, the mean IOP showed significantly decreased in the phaco-visco group compared to the phaco group (P < 0001 and P = 0.004, respectively), but it was not statistically significant at 6th and 12th months (P = 0.540 and P = 0.530). The need for antiglaucoma medication and the complete and qualified success rates were significantly in favour of the phaco-visco group in all postoperative visits (P < 0.05). CONCLUSIONS: Although both phacoemulsification alone and phacoviscocanalostomy procedures can be considered for patients with mild-to-moderate OAG, we found better success rates using phacoviscocanalostomy. Therefore, if the surgeon is an expert in performing this technique, this non-penetrating procedure can be applied in patients with visually significant cataract and earlier stages of OAG, especially in patients with PEXG.

A Comparison between Wavefront-Optimized and Wavefront-Guided Photorefractive Keratectomy in Patients with Moderate-to-High Astigmatism: A Randomized Clinical Trial.

Purpose: To compare clinical outcomes of wavefront-optimized (WFO) and wavefront-guided (WFG) photorefractive keratectomy (PRK) in patients with moderate-to-high astigmatism. Methods: Patients with corneal cylinder above 2 diopters and myopic spherical equivalent were randomized into WFO or WFG PRK. Visual acuity (VA), refraction, contrast sensitivity, higher-order aberrations (HOAs), and astigmatic vector differences were documented and compared for 6 months after surgery. Results: The total number of 362 eyes from 181 patients was analyzed. The amount of total aberration was reduced 2.7 root mean square (RMS) and 2.9 RMS in the WFO and WFG groups, respectively (P < 0.001 in each group and between the groups). HOAs including coma, trefoil, and spherical aberrations increased in both the groups (P < 0.001) but were significantly more in the WFO group (P < 0.001). The increased spherical aberration was similar in both the groups (P = 0.12). Surgically induced astigmatism was not significantly different between the groups (P = 0.20). The magnitude of error was significantly higher in the WFO group (P < 0.001), but the absolute angle of error and the arithmetic angle of error were not significantly different between the groups (P = 0.20 and P = 0.30, respectively). Conclusion: WFO and WFG platforms of PRK appear comparable in terms of VA, refractive correction, and total aberration. Yet, HOAs may increase especially after WFO PRK.

Current and Emerging Therapies for Limbal Stem Cell Deficiency.

The corneal epithelium serves to protect the underlying cornea from the external environment and is essential for corneal transparency and optimal visual function. Regeneration of this epithelium is dependent on a population of stem cells residing in the basal layer of the limbus, the junction between the cornea and the sclera. The limbus provides the limbal epithelial stem cells (LESCs) with an optimal microenvironment, the limbal niche, which strictly regulates their proliferation and differentiation. Disturbances to the LESCs and/or their niche can lead to the pathologic condition known as limbal stem cell deficiency (LSCD) whereby the corneal epithelium is not generated effectively. This has deleterious effects on the corneal and visual function, due to impaired healing and secondary corneal opacification. In this concise review, we summarize the characteristics of LESCs and their niche, and present the current and future perspectives in the management of LSCD with an emphasis on restoring the function of the limbal niche.

Outcomes of the infantile cataract surgery: case series with a 5-year follow-up.

PURPOSE: To present the 5-year outcomes obtained from the infantile cataract surgery in pediatric population. METHODS: Medical records of all patients with unilateral or bilateral infantile cataract who had undergone lensectomy and anterior vitrectomy with or without intraocular lens implantation before 10 years of age were evaluated. Patients with any history of ocular trauma, retinal or corneal dystrophy, ocular or orbital surgery, retinopathy of prematurity, raised intraocular pressure at the time of diagnosis, or incomplete follow-up sessions were excluded from the research. RESULTS: A total of 85 eyes belonged to 52 patients were analyzed. Bilateral and unilateral diseases were present in 33 (63.5%) and 19 (36.5%) patients, respectively. After performing the first operation, 43 (50.6%) eyes still remained aphakic. The mean corrected distance visual acuity (CDVA) of the aphakic and pseudophakic eyes was estimated as 0.77 ± 0.52 and 0.43 ± 0.39 logMAR with no statistical difference. The age at the time of performing the cataract surgery was not associated with the final CDVA in either group. Complications in the anterior segment structures were noted in 39 (45%) eyes. Strabismus and amblyopia were noted in 52 (61%) and 75 (88.2%) eyes, respectively. Glaucoma was found in 17 (20%) eyes with no correlation with the final CDVA, age at the time of cataract surgery, or the status of the lens. CONCLUSION: Due to high prevalence rates of amblyopia, strabismus, and glaucoma after the infantile cataract surgery, specific attention should be paid to these complications in each follow-up examination.

Association of central serous chorioretinopathy with single nucleotide polymorphisms in complement factor H gene in Iranian population.

OBJECTIVES: To investigate the association of two different single nucleotide polymorphisms (SNPs) in the complement factor H (CFH) gene with central serous chorioretinopathy (CSCR) in the Iranian population. METHODS: This is a case-control study with 95 participants in each group who were stratified according to their various ethnical variations. Primers for rs1329428 and rs3753394 polymorphisms were synthesized. DNA was extracted from peripheral blood leukocytes and underwent PCR and high-resolution melt analysis. RESULTS: The frequency of tt, ct, and cc genotypes for rs1329428 polymorphism was 22 (26.5%), 46 (55.4%), and 15 (18.1%) in acute CSCR and 5 (41.7%), 5 (41.7%), and 2 (16.7%) in chronic CSCR respectively with no significant difference between case and control groups. The frequency of tt, ct, and cc genotypes for rs3753394 polymorphism was 31 (37.3%), 14 (16.9%), and 38 (45.8%) in acute CSCR and 4 (33.3%), 3 (25%), and 5 (41.7%) in chronic CSCR respectively. There was a significant difference between patients of Persian descent and controls in rs3753394 polymorphism (P = 0.00, chi-square test). There was no statistical difference in the frequency of polymorphism between acute and chronic patients (P = 0.64 and P = 0.79 respectively, chi-square test). CONCLUSIONS: The rs3753394 polymorphism is probably associated with CSCR in Persian ethnicity. Further studies are required to validate the implications of this finding in clinical practice.

Corneal cross-linking for keratoconus: Evaluation of the retina and choroid.

PURPOSE: To investigate the possible structural changes of the central choroid and retina after collagen cross-linking (CXL) in patients with progressive keratoconus (KCN). METHODS: Twenty-five eyes of 25 patients were included in this study. Patients underwent enhanced depth imaging optical coherence tomography (EDI-OCT) before and 1 month after CXL. The values for central macular thickness (CMT), subfoveal choroidal thickness (CHT), and choroidal volume (CHV) were evaluated. RESULTS: CMT before and after CXL was 263.24 ± 16.25 µm and 263.20 ± 16.51 µm, respectively (p = 0.98). CHT was 362.08 ± 36.80 µm and 367.84 ± 33.67 µm before and after CXL, respectively (p = 0.26). CHV was 8.74 ± 0.33 mm3 and 8.68 ± 0.36 mm3 before and after CXL, respectively (p = 0.11). There was no significant difference in the corrected distance visual acuity before and after CXL (0.06 ± 0.05 and 0.05 ± 0.05 logMAR, respectively, p = 0.65). CONCLUSION: Central retinal and choroidal thicknesses are not changed after corneal cross- linking.

Ganglion cell complex and macular thickness layers in primary open-angle glaucoma, pseudoexfoliation glaucoma and healthy eyes: A comparative study.

PURPOSE: To investigate the differences in the ganglion cell complex (GCC) and macular thickness measurements between primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), and healthy eyes with optical coherence tomography (OCT)optovue. METHODS: In this non-randomized comparative cross-sectional study, 43 healthy eyes, 68 POAG eyes, and 57 PXG eyes were included. Patients were matched for age and disease severity. OCT angiography images were obtained for automated measurement of the GCC and macular thickness layers (inner and outer). RESULTS: All GCC parameters were significantly difference between healthy and glaucomatous eyes (mild, and moderate to severe disease).There were no significant differences in GCC parameters between POAG and PXG patients except focal loss volume (FLV) after adjustment. Moderate to severe PXG eyes exhibited significantly lower GCC, larger global loss volume (GLV) values, and FLV values when compared with mild PXG eyes (p<= 0.05). We found significant thinning patterns in inner retinal thickness (fovea, parafovea, and perifovea), and total retinal thickness (parafovea, and perifovea) in moderate to severe PXG eyes when comparing with POAG eyes. Patients with moderate to severe PXG also showed significantly thinning patterns in inner retinal layers (fovea, parafovea and perifovea) and total retinal thickness (nasal parafovea) in compared to mild PXG. CONCLUSION: It appears that GCC thickness is not significantly different between POAG and PXG except FLV. Despite similar retinal thickness in mild disease, a significant reduction in total and inner retinal thickness was demonstrated in moderate to severe PXG compared to moderate to severe POAG, in fovea, parafovea and perifovea region.

Open globe injuries in geriatric population in Iran: characteristics and outcomes.

AIM: To investigate the patterns and outcomes of open globe injuries in the elderly population in Iran. METHODS: In this retrospective cross-sectional chart review, medical records of 248 patients (aged 60y and more) with the diagnosis of open globe injury from 2006 to 2016 were reviewed. Demographic features, type, and mechanism of open globe injury, ocular trauma score (OTS), visual acuity before and after treatment, the zone of injuries, and the associated injuries found at the presentation or thereafter were documented. RESULTS: A total of 248 eyes of 248 patients were included. The mean age was 69.2±5.8y (range: 60-90y). Male/ female ratio was about 3:1 (187 vs 61). The three most common causes of injury were falling (25.2%), sharp objects (18.9%), and tree branches (13.9%). Penetrating injury accounted for most of the geriatric ocular trauma (50.4%), followed by globe rupture (40.3%), intraocular foreign body (IOFB; 7.3%), and perforating injury (2.0%). The median raw OTS for the population was 60.5 and the most common OTS class was 3. The injuries tend to affect zone I more than zone II and zone III. The only predictor of final visual acuity was the class of OTS (P<0.001). CONCLUSION: Geriatric open globe injury should be valued specifically. The most common type of open globe injury in Iran is penetrating injuries but falling remain the main cause. The OTS class must be considered as an important predictor of final visual acuity.

Intravitreal anti-vascular endothelial growth factor medications during pregnancy: current perspective.

PURPOSE: Anti-vascular endothelial growth factor (VEGF) medications are widely used for treatment of a number of vitreoretinal disorders. However, the evidence for their effect on fetal and maternal health during pregnancy is very limited. The goal of this article is to accumulate evidence for the indications of anti-VEGF medications during pregnancy and their effects on maternal and fetal health. METHODS: Review of literature regarding anti-VEGF administration during pregnancy and using PubMed database without language or date limit. RESULTS: The main indications for treatment with intravitreal anti-VEGF medications include choroidal neovascularization (CNV) followed by retinal vascular occlusion (RVO) and complications of diabetes such as neovascular glaucoma, diabetic retinopathy (DR) and diabetic macular edema (DME). Among anti-VEGF medications, only ranibizumab and bevacizumab have been used during pregnancy with latter by far more than the former. CONCLUSION: Women of childbearing age should be consulted regarding the potential adverse effects of anti-VEGF medications on fetal health and the risk of early pregnancy loss. They should be strongly encouraged to use appropriate contraceptive methods during treatment. A timely obstetrics consultation may help in this situation. Attempt for pregnancy should be withheld for at least 3 months following last injection of ranibizumab and aflibercept, and for at least 6 months following last injection of bevacizumab.

Management Strategies of Ocular Chemical Burns: Current Perspectives.

Ocular chemical burns are absolute ophthalmic emergencies and require immediate management to minimize devastating sequelae. Management of alkali and acid burns is started at the scene of the accident by copious irrigation. Treatment is directed at improving epithelial integrity and stromal stability, reduction of undue inflammation, and prevention or timely management of complications. To ascertain the best possible outcome, numerous biological medications and surgical interventions have been merged into conventional therapeutic regimens. These include autologous and umbilical cord serum preparations, platelet-rich plasma, amniotic membrane transplantation, limbal stem-cell transplantation, and anti-angiogenic agents.

Accuracy of Swept-Source Optical Coherence Tomography and Ultrasound Biomicroscopy for Evaluation of Posterior Lens Capsule in Traumatic Cataract.

PURPOSE: To assess the efficacy of swept-source optical coherence tomography (SS-OCT) and ultrasound biomicroscopy (UBM) in detecting posterior capsule (PC) defect in patients with traumatic cataract. DESIGN: Observational case-series. METHODS: Sixty-seven eyes from 67 patients, with traumatic cataract severe enough to prevent slit lamp evaluation of the PC, were included in a simple sequence without randomization. Patients underwent both 50-MHz UBM and SS-OCT evaluation of the PC by different operators. Cataract surgery was then performed using a single technique. RESULTS: Sixty-seven eyes from 67 patients including 60 men and 7 women were studied. The mean age was 34 ± 14 years and the mean logarithm of minimal angle of resolution of visual acuity was 1.89 ± 0.71. The calculated sensitivity, specificity, and accuracy values for SS-OCT were 96.8% (95% confidence interval [CI] 83.81-99.43), 66.7% (95% CI 48.78-80.77), and 82% (95% CI 70.53-89.62), respectively. For UBM, sensitivity, specificity, and accuracy values were 82.6% (95% CI 62.86-93.02), 57.9% (95% CI 36.28-76.86), and 71.4% (95% CI 56.43-82.83), respectively. Positive predictive and negative predictive values for SS-OCT were 75% (95% CI 59.81-85.81) and 95.2% (95% CI 77.33-99.15) and for UBM were 70.4% (95% CI 51.52-84.15) and 73.3% (95% CI 48.05-89.1), respectively. CONCLUSION: Although both imaging techniques are effective, SS-OCT appears to be at least comparable, or superior in special circumstances, to UBM in detecting preoperative posttraumatic PC rupture. We recommend preoperative assessment of all traumatic cataracts with SS-OCT as a part of surgical planning.

Treatment of Acute Corneal Hydrops With Combined Intracameral Gas and Approximation Sutures in Patients With Corneal Ectasia.

PURPOSE: To assess the efficacy and safety of combined intracameral sulfur hexafluoride and full-thickness corneal sutures in the treatment of acute corneal hydrops (CH). METHODS: This is an uncontrolled series of cases with keratoconus (KC), keratoglobus (KG), and pellucid marginal degeneration that presented with CH of recent onset. RESULT: Thirteen patients completed the study. The mean corneal thickness before treatment was 1,310 (Equation is included in full-text article.)556 µm, which significantly reduced to 660 ± 148 µm at week 1 postoperatively (P = 0.001). It took 11.5 ± 6.5 days for corneal edema to resolve with a minimum and maximum of 5 and 24 days, respectively. Corrected distance Snellen visual acuity (CDVA) significantly improved from 0.04 ± 0.03 before treatment to 0.08 ± 0.06 at week 1 (P = 0.035) and continued to improve through month 1 [(0.11 ± 0.05), P = 0.007] and month 3 [(0.15 ± 0.08), P = 0.002]. No patient needed re-treatment with gas injection, and no complication was detected during the follow-up period. CONCLUSIONS: Combined intracameral gas injection and approximation sutures are probably effective and safe for the treatment of acute CH. This treatment results in rapid recovery with very rare complications.

The association between personality disorders/traits and violent eye trauma.

AIMS: To determine the prevalence of various personality disorders in patients with open globe injuries caused by violent eye trauma. MATERIALS AND METHODS: One-hundred patients were divided equally to case and control groups. The case group was selected from admitted patients with open globe injury following a violent act. We considered open globe injuries not involved in violence as the control group. All patients interviewed using SCID-II questionnaire. RESULTS: The mean age was 30.7 ± 9.2 year and 34.4 ± 13.1 year for the case and control groups, respectively, (P > 0.05). The married population was more frequent in the control group (P = 0.027). Forty-three patients (86%) in the case group and 23 patients (46%) in the control group demonstrated some personality disorder (P < 0.001). In both groups, cluster B was most frequent. The antisocial personality disorder was more prevalent in the case group. (P = 0.046 and P = 0.006, respectively). The ocular trauma score (OTS) and the mean visual acuity was significantly worse in the case group (P = 0.028 and P = 0.044). CONCLUSIONS: Personality disorders are probably important factors in those who acquire an open eye injury during violent behavior. This group had a poor visual outcome. We suggest that this population merits appropriate psychiatric consultation for detection of personality disorders.

The rate of endophthalmitis after pars plana vitrectomy and its risk factors.

PURPOSE: To study the incidence of endophthalmitis after pars plana vitrectomy, its causative organisms, and visual acuity outcomes. PATIENTS AND METHODS: In this retrospective, comparative study, the medical records of patients with acute-onset postoperative endophthalmitis after pars plana vitrectomy at Farabi Eye Hospital, Tehran, Iran, during a 12-year period between January 2004 and November 2015 were reviewed. To compare the endophthalmitis patients with other cases who underwent pars plana vitrectomy at the same day and also the same operating room, a control group was developed by gathering the data from surgical records. RESULTS: In the present study, the incidence rate of pos- vitrectomy endophthalmitis was 0.04% (16/39783). The organisms identified in aqueous or vitreous cultures (culture positive 44%) included Streptococcus pneumoniae (two patients, 12.5%), Pseudomonas aeruginosa (two patients, 12.5%), fungi (two patients, 12.5%), and Streptococcus viridans (one patient, 6.25%). Visual acuity after treatment for endophthalmitis ranged from light perception (7 eyes) to hand motion (1 eye), and evisceration was performed in 8 eyes (50%). When comparing the cases (patients developing endophthalmitis) and controls (patients with no complications operated in the same day and place of operation with the case group), only not using tamponade showed a statistically significant relation with the occurrence of endophthalmitis (p = 0.034). CONCLUSION: Our results indicated low incidence of endophthalmitis after pars plana vitrectomy comparable to previous studies which resulted in poor visual acuity. It seems that not using tamponade might increase the risk of endophthalmitis among these patients.

A survey of incidental ocular trauma by pencil and pen.

AIM: To determine characteristic features of ocular trauma resulted from self-trauma by writing instruments among pediatric population. METHODS: Thirty-six children who suffered from self-inflicted ocular trauma with a writing instrument were included in this prospective cross-sectional study. RESULTS: The mean age was 5.6±2.7y with male: female ratio of 1.77. The right eye was involved two times more than the left eye. The superomedial (55.5%) and inferomedial (30.6%) quadrants were the most common sites of injury. The leading culprit was colored pencils (44.4%). During surgical exploration, no foreign body (FB) was found in 25 (69.4%) patients while an FB was found in 11 (30.5%) patients. Brain injury was present in two patients (5.6%) and only in superomedial quadrant injuries. Zone 1 was the most common site for ocular trauma associated with penetrating injury. The mean ocular trauma score (OTS) in penetrating injuries was 3.8±1.2. The best corrected visual acuity (BCVA) was 0.3±0.6 upon admittance and 0.08±0.21 after one year. The final BCVA was significantly correlated with the entrance site, better final BCVA was found in nasal entrance site (P<0.05). CONCLUSION: The ophthalmologists should keep a high index of suspicion to rule out penetrating eye injuries related to writing instruments in a young uncooperative child. Brain injury is a life-threatening event that should be ruled out by appropriate imaging. Medial canthal area as the most common site needs an especial attention in writing instrument injuries.

Association between Family History and Keratoconus Severity.

PURPOSE: The high prevalence of positive family history of keratoconus (KC) in KC patients is well-known. However, the results regarding the association between family history of KC and disease severity are controversial. The aim of this study was to evaluate the possible association between family history and severity of KC. METHOD: Clinical data of 1496 KC patients were evaluated. All participants were asked if they had had a family member with KC. Topographic and keratometric measurements of KC patients, including central corneal thickness (CCT), thinnest corneal thickness (TCT), mean, flat, and steep keratometry values (K) by the use of Pentacam, best-spectacle corrected visual acuity (BCVA), spherical equivalent (SE), and astigmatism were recorded and compared according to patients with and without a family history of KC, first- or second-degree family members, and the number of family members with KC. Severity of KC was classified according to the Amsler-Krumeich classification. RESULTS: Family history of KC was present in 292 (19.5%) patients. Of those 292 patients who had a family history of KC, 159 (54.5%) had one family member with KC and 133 (45.5%) had two or more family members with KC. There was not a significant difference between corneal pachymetry and K values of the patients with and without a family history of KC (p > 0.05). However, those with a positive family history of KC had more severe disease, according to the Amsler-Krumeich classification (p < 0.05). KC patients who had more family members with KC had significantly lower TCT and significantly higher steep K and astigmatism (p < 0.05), and had more severe disease, according to the Amsler-Krumeich classification (p < 0.05). CONCLUSION: We suggest that patients with more family members with KC should be subject to screening to identify early disease.

Association between the prevalence of obstructive sleep apnoea and the severity of keratoconus.

AIM: The purpose of this study was to determine the association between prevalence of obstructive sleep apnoea (OSA) in patients with keratoconus (KC) and the severity of KC. METHODS: Six-hundred and sixteen patients with KC and 616 patients without KC in the control group were enrolled in this prospective case-control study. Both groups were matched by age, gender, and body mass index (BMI). The Berlin Questionnaire was administered in both groups. Keratometric and topographic measurements of the KC eyes were recorded. RESULTS: Seventy-six (12.3%) and 40 (6.5%) patients were identified as high risk for developing OSA in KC and control groups, respectively (p<0.001). Family history of OSA and BMI were the risk factors for OSA in the KC group, while in the control group the only risk factor for OSA was the patient's gender. Patients with KC with a high risk of OSA had a significantly higher mean K, flat K, steep K (p<0.05), and a thinner corneal thickness (p<0.05). The severity of KC decreased in both OSA groups except for the grade 4 of high risk group which was the second most frequent group after grade 1 (p=0.005). CONCLUSIONS: Our study revealed that patients with KC are at increased risk of developing OSA, and patients with KC who are at higher risk of developing OSA may have more severe KC.

Keratoconus Clinical Findings According to Different Classifications.

PURPOSE: To demonstrate the topographic and keratometric findings in patients with keratoconus (KC), according to age, sex, and KC severity groups. METHODS: A total of 2073 eyes of 1081 patients with KC were consecutively diagnosed and enrolled in this prospective cross-sectional study. All patients underwent ophthalmic examination and Pentacam (Oculus Optikgerate GmbH) measurements. The patients were divided into different groups according to their age, sex, Amsler-Krumeich classification, and keratoconus severity score classification. Keratometric (K) values (flattest, steepest, and mean), central and thinnest corneal thickness, and manifest refraction were recorded for each patient with KC and they were then compared according to the patient's age, sex, and KC severity groups. RESULTS: The age (mean ± SD) of the population was 24 ± 7 years. The average central corneal thickness and mean K of all patients were 462 ± 45 µm and 48.8 ± 4.8 diopters, respectively. Female patients with KC were significantly younger and had significantly higher K values and lower anterior chamber depth than those of men. All parameters except for the pupil diameter and astigmatism were significantly associated with KC severity grades. The thinnest corneal thickness was the most important and also the most sensitive and specific parameter for distinguishing all stages of KC severity in all KC severity classifications. The Amsler-Krumeich classification had the most correlation with other severity classifications. CONCLUSIONS: The results of this study enable clinicians and researchers to understand better the differences between clinical characteristics between sex, age groups, and the changes in clinical characteristics during disease progression, which may lead to further advancement in KC management.