Assessment of tear inflammatory cytokines concentration in patients with diabetes with varying severity of involvement.

Diabetic retinopathy (DR), as one of the most important causes of blindness in Western societies, is a common micro-vasculopathy associated with diabetes. There is growing evidence of the role of inflammation in its development. This study was designed to measure cytokines in patients with diabetes with different stages of retinopathy .In this study, tear concentrations of three types of cytokines with different angiogenic properties including IL-1RA, IL-8, and TNF-α were measured in patients with diabetes without retinopathy, with non-proliferative retinopathy, with proliferative retinopathy, and in a healthy control group. The results showed that concentrations of TNF-α and IL-8 were higher in the tear sample of diabetics than in the control group and the concentrations of these cytokines were higher in patients with more advanced stages of diabetes, while the tear level of IL-1RA was significantly lower in diabetics. Based on these findings, it can be concluded that diabetes and its progression of severity affects the tear levels of IL-1RA, IL-8, and TNF-α inflammatory cytokines.

Cataract Grading in Pure Senile Cataracts: Pentacam versus LOCS III.

Purpose: To determine the diagnostic accuracy of Pentacam Cataract Grading Scale (PCGS) versus the Lens Opacities Classification System (LOCS III) in scaling pure age-related cataract. Methods: Between April 2016 and May 2017, eyes of 281 patients were evaluated for grading of lens opacity. We used LOCS III and PCGS. Patients with pure age-related cataract with no previous history of eye surgery, eye trauma, or chronic systemic disease between 50 and 95 years of age were included. The examination of the patients was done, using slit lamp and LOCS III grading chart. The second examination was done a week later, using Oculus Pentacam. Next, we graded them using a PNS grading score. Spearman's rank correlation and a Bland-Altman Plot were implemented for analysis using MedCalc 14. 8.1. P < O.05 was considered as statistically significant. Results: Three hundred eyes were examined. Of them, 189 patients were male, and patients between 70 to 80 years old were the most common group. The correlation between grades of two methods was 0.47 (P < 0.001). Results of the Bland-Altman plot showed a moderate alignment between the two methods. Conclusion: The association between LOCSIII and PCGS is not so favorable, however, it is an economical and effective method to assess lens opacities is LOCSIII. PCGS can be used in early diagnosis. For a definitive diagnosis and appropriate therapeutic intervention, an ophthalmological examination is needed.

Management of uncomplicated primary retinal rhegmatogenous detachment.

PURPOSE: The purpose of this study was to compare the vitreoretinal surgery outcomes in patients with uncomplicated rhegmatogenous retinal detachment (RRD). DESIGN: This was a retrospective, nonrandomized consecutive case series study. PARTICIPANTS: Six hundred and eighty-three eyes with primary uncomplicated RRD between 2013 and 2017 were included in this study. METHOD: Patients were treated by one of the following methods: pars plana vitrectomy (PPV), scleral buckling (SB), and combined PPV with SB (PPV + SB). The success rate was divided into an anatomical and functional one, the anatomical success rate was retinal reattachment, and the functional success rate was defined as a statistically significant improvement in BCVA patients within a 6-month follow-up period. RESULTS: This study involved 683 eyes; of these, 79 eyes underwent PPV, combined PPV/SB was performed on 180 eyes, and 424 eyes underwent SB. The anatomical success rates were 83.5% for PPV and 80% for combined SB/PPV. The anatomical success rate for the SB group was 75.5%. There were no significant differences between these groups in terms of anatomical success rates (0.191) or functional success rates (p = 0.534). There was no significant difference between the PPV alone and PPV + SB in terms of the likelihood of anatomic success (p-value: 0.503) or functional success (p-value: 0.839). Preoperative worse BCVA and presence of PVR were associated with poor prognosis (p-value: 0.024, 0.013, respectively). CONCLUSION: In the setting of appropriate instruments for microincision pars plana deep vitrectomy, it seems the surgical outcomes of scleral buckling and PPV are not different in patients with primary uncomplicated RRD. The supplementary band has not additional benefits in patients who underwent PPV with this type of RRD.

A systematic review of Amblyopia prevalence among the children of the world.

Objective: to assess the prevalence of Amblyopia disease in the children of the world. Methods: In order to perform this systematic review, PICO was considered as the research question. Then, the preferred keywords were searched in Medline (via PubMed), Embase, Scopus, Web of Science, and ProQuest databases. The retrieved citations were reviewed by two independent inspectors in a three-step process in terms of the title, abstract, and full-text, based on the inclusion criteria. The studies included in the review were critically evaluated and then were extracted by two dependent expert reviewers. Finally, the prevalence of Amblyopia disease in the children of the world was pooled by meta-analysis CMA v.2 software. The heterogeneity of the selected studies was evaluated using I2 and chi-square. Also, subgroup-analysis was performed using designs and continents. Results: Out of 952 retrieved citations, 131 studies were included. The total prevalence of Amblyopia in the children of the world was calculated to be 4.3% [Pooled Prevalence: 4.3%, 95% CI: 2.6%-7.00%, P-value 0.0001]. In addition, the heterogeneity of the studies was reported to be high (Q: 48281.18, df: 56, p-value 0.001, I-square: 99.88). The subgroup analysis showed that America had the highest (5.57%, 95% CI: 2.23%-13.94%, P-value 0.0001) prevalence, and the lowest prevalence of Amblyopia in the children of the world was seen in Africa (7.1%, 95% CI: 0.003%-172.53%, P-value 0.05). Conclusion: It can be concluded that the total prevalence of Amblyopia is 3.4%, but this estimate varies in all continents, especially in Africa. The major reason for this variation was reported to be the heterogeneity of studies. These assessments have investigated different populations in terms of severity of illness, age, and gender. Therefore, further worldwide high-quality and valid studies should be carried out to allow the calculation of the real prevalence of Amblyopia among children of the world. Abbreviations: VA = visual acuity, ALSPAC = Avon Longitudinal Study of Parents and Children, JBI = Joanna Briggs Institute, PRISMA = Systematic Review and Meta-analysis, CMA = Comprehensive Meta-analysis Software.

Comparison of the effect of mitomycin C and bevacizumab-methylcellulose mixture on combined phacoemulsification and non-penetrating deep sclerectomy surgery on the intraocular pressure (a clinical trial study).

PURPOSE: Comparison of the effect of mitomycin C (MMC) versus bevacizumab-methylcellulose mixture (BMM) on combined phacoemulsification and non-penetrating deep sclerectomy surgery on the intraocular pressure in patients with open-angle glaucoma was made. METHODS: The current study is a controlled, randomized, double-blind clinical trial. Thirty-eight patients were enrolled, with a total of 40 eyes, and underwent a combined phacoemulsification and non-penetrating deep sclerectomy surgery from 2016 to 2017. MMC with concentration of 0.2 mg/mL for 2 min was used for 20 eyes before separating the scleral flap, and 0.3 mL of BMM (bevacizumab 1.25 mg incorporated into 2% methylcellulose) was injected subconjunctivally following surgery. The success rate of surgery was categorized as complete, relative and failure. Fisher's exact, Mann-Whitney U and Chi-square tests were employed to data analysis. A p value < 0.05 was supposed significant. RESULTS: Patients had the same distribution in terms of age, sex, type of glaucoma and type of cataract. Patients were followed up for a mean of 6 months. The mean intraocular pressure before surgery in the MMC group was 24.85 ± 2.83 mmHg with 3.2 ± 0.523 anti-glaucoma drugs, which reached 13.75 ± 3.552 mmHg with 0.15 ± 0.489 anti-glaucoma drugs at the latest visit. The average intraocular pressure before surgery in the BMM group was 24.45 ± 2.48 mmHg with 2.9 ± 0.641 anti-glaucoma drugs, which reached 15.40 ± 3.267 mmHg with 0.25 ± 0.55 anti-glaucoma drug at the last follow-up. The intraocular pressure was notably lower in the MMC group than BMM group 6 months after surgery. There was not a significant difference from the aspect of success rate and failure rate among the two groups at the 6-month follow-up (p = 0.135). DISCUSSION: Based on the results of this study, MMC and bevacizumab-methylcellulose both seem to be effective in the success of combined phacoemulsification and non-penetrating deep sclerectomy surgery, but MMC decreases intraocular pressure in patients at 6 months post-surgery.

Corneal densitometry and its correlation with anterior and posterior elevation in keratoconus / 国际眼科杂志(Guoji Yanke Zazhi)

· AIM:To evaluate the corneal densitometry in treatmentnaive patients with keratoconus and its relevance with anterior and posterior corneal elevation.· METHODS:Keratoconic corneas were examined using the Pentacam.Corneal densitometry was measured over a 12-mm diameter area,divided by annular concentric zones and depths,more over anterior and posterior corneal elevation was measured.Keratoconus was classified according to the topographic keratoconus classification.· RESULTS:A total of 152 subjects [72 patients with keratoconus (46 male,26 female) and 80 healthy control subjects (50 male,30 female)] were included in the study.There were significant differences in corneal densitometry values of the groups in central 2 mm keratoconus (KC)=19.62±4.17 gray scale unit (GSU),N=15.38±1.54 GSU(P＜0.0001),and in annulus of 2 to 6 mmin diameter (K=16.40±2.18 GSU,N=15.31±1.25 GSU,P＜0.0001).When densitometry values for different depths were examined,the anterior layer presented the highest value (KC =23.69±3.71 GSU,N =20.91 ±2.52 GSU,P＜0.0001),which was significantly higher than the values obtained in the central and posterior layer (KC =14.34± 1.70 GSU,N=13.61±1.21 GSU,P=0.001 and KC=11.40± 1.23 GSU,N =12.35±0.88,P=0.002 respectively).Analysis of the correlation between corneal densitometry for each layer depth (anterior,central and posterior) with posterior corneal elevation values demonstrated significant association (r =0.293,r =0.278 and r =0.294 respectively).The similar correlation was not found between corneal densitometry for each layer depth and anterior corneal elevation (r=-0.211,r=-0.101,r=0.99 respectively).In the control patients such a significant correlation between posterior/anterior corneal elevation and corneal light backscatter for each layer depth was not found.· CONCLUSION:The densitometry map reveals that light backscatter was higher in the central portion of the anterior keratoconic cornea.Corneal densitometry values of keratoconus patients were correlated with posterior corneal elevation in 0-2,6-10 and 10-12 annuli and in all anterior,central and posterior layers.The densitometry level was higher in more advanced stages.

Tear film inflammatory mediators in patients with keratoconus.

To determine the concentration of inflammatory mediators in the tear film of patients with keratoconus. Basal tears from patients with keratoconus and from normal controls were collected using a capillary tube. Patients with keratoconus were examined in a routine fashion, and keratometric readings were also taken from corneal topographic maps .The concentration of cytokines including Interleukin 6,10,1b and Interferon-γ was measured by enzyme-linked immunoadsorbent assay. Seventy-two subjects were enrolled in the study including 42 patients with keratoconus and 30 normals. Patients with keratoconus had significantly higher levels of Interlukin 6,1b and Interferon-γ (17.49 ± 1.92 pg/ml), (8.58 ± 1.15 pg/ml), and (33.33 ± 7.57 pg/ml) compared with control subjects (13.81 ± 1.71 pg/ml), (4.98 ± 0.52 pg/ml), and (22.99 ± 4.68 pg/ml), (P = 0.0001, P = 0.0001, and P = 0.0001). But the level of Interlukin-10 in keratoconus patients was significantly lower (6.07 ± 1.35 pg/ml) than controls (8.99 ± 0.70 pg/ml) (P = 0.0001). We realized that the proinflammatory markers (Interlukin-6,1-b and Interferon-γ) are over expressed, whereas the anti-inflammatory marker (Interlukin-10) is under expressed, indicating that the pathogenesis of keratoconus may involve complex chronic inflammatory events. Additional future studies will reveal the exact molecular and biochemical mechanisms that are required to better manage the disease and halt its progression.

Characteristics and clinical presentations of pediatric retinoblastoma in North-western Iran.

AIM: To report the characteristics and clinical presentations of retinoblastoma in a series of pediatric patients from Iran. METHODS: In this retrospective study, profiles of pediatric patients with retinoblastoma archived in a referral eye hospital in north-west of Iran during 7 years (n=40 patients with 57 eyes) were reviewed. Demographics, as well as the laterality, clinical manifestations and the types of treatment were the major endpoints. The Student's t test, Mann-Whitney U-test, Chi-square or Fishers' Exact test was used for analysis where appropriate. RESULTS: There were 23 cases (57.7%) with unilateral and 17 cases (42.5%) with bilateral involvement. The male to female ratio was 1 to 1.4 with a mean admitting age of 24.0±11.3 (range: 5-62) months. The mean diagnosis delay was 7.4±9.6 months (range: 10 days to 13 months). The most common presenting sign was leukocoria (97.5%) followed by proptosis (7.5%), strabismus (7.5%), hyphema (5%), orbital cellulitis (5%) and glaucoma (2.5%). Enucleation was performed in 95.7% of the cases with unilateral involvement and at least one eye of the patients with bilateral disease. A second enucleation was performed in other 3 patients (17.6%) of the latter group. CONCLUSION: This is the first study evaluating a series of Iranian children with retinoblastoma.

Surgical treatment of severely traumatized eyes with no light perception.

PURPOSE: The purpose of this study was to evaluate the anatomical and functional outcomes of surgical intervention in severely traumatized eyes with no light perception (NLP). METHODS: In this prospective interventional case series, 18 eyes of 18 patients with severe ocular trauma whose vision was documented as NLP and with relative afferent pupillary defect of 3 to 4+ underwent deep vitrectomy and other appropriate procedures 1 to 3 times. RESULTS: Vision was NLP in all eyes at the time of surgery, which was performed 3 days to 14 days after the initial trauma. During a mean follow-up period of 20.5 +/- 5.2 months (range, 11-36 months), except for 1 case of phthisis, other eyes achieved acceptable anatomical and functional outcomes. Postoperative vision was NLP in 2 eyes (11.1%), light perception in 3 eyes (16.7%), hand motions in 4 eyes (22.2%), counting fingers in 3 eyes (16.7%), and 20/200 or better in 6 eyes (33.4%). CONCLUSION: After eye trauma, NLP vision and relative afferent pupillary defect of 3 to 4+ alone may not be an indication for enucleation. Performing exploratory surgery within 14 days after the injury may salvage the globe and improve vision; this approach also entails positive psychologic effects for patients and relatives.