Concurrent Collagenous Gastritis and Collagenous Colitis: A Case Presentation and Review of the Literature.

Collagenous gastritis is a rare gastrointestinal condition, and its presence with collagenous colitis may be an exception. We describe a 31-year-old man with simultaneous collagenous gastritis and collagenous colitis. The patient initially presented with dyspepsia, anemia, and weight loss. Endoscopy assessment revealed irregular gastric atrophy with the normal colon. Gastric biopsies illustrated increased thickness and subepithelial collagen band.

Generation of Retinal Pigmented Epithelium-Like Cells from Pigmented Spheres Differentiated from Bone Marrow Stromal Cell-Derived Neurospheres.

Background: Retinal degeneration causes blindness, and cell replacement is a potential therapy. The purpose of this study is to formation of pigmented neurospheres in a simple medium, low-cost, high-performance manner over a short period of time while expressing markers of RPE cells and the activation of specific genes of the pigment cells. Also, these neurospheres have the ability to produce a monolayer of retinal pigment epithelium-like cells (RPELC) with the ability of photoreceptor outer segment phagocytosis. Methods: BMSC were isolated from pigmented hooded male rats and were immunoreactive to BMSC markers, then converted into neurospheres, differentiated into pigmented spheres (PS), and characterized using Retinal pigment epithelium-specific 65 kDa protein (RPE65), Retinaldehyde-binding protein 1 (CRALBP) and orthodenticle homeobox 2 (OTX2) markers by immunocytochemistry, RT-PCR and RT-qPCR. The PS were harvested into RPELC. The functionality of RPELC was evaluated by phagocytosis of fluorescein-labeled photoreceptor outer segment. Results: The BMSC immunophenotype was confirmed by immunostained for fibronectin, CD90, CD166 and CD44. These cells differentiated into osteogenic and lipogenic cells. The generated neurospheres were immunoreactive to nestin and stemness genes. The PS after 7-14 days were positive for RPE65 (92.76-100%), CRALBP (95.21-100%) and OTX2 (94.88-100%), and after 30 days RT-PCR, qPCR revealed increasing in gene expression. The PS formed a single layer of RPELC after cultivation and phagocyte photoreceptor outer segments. Conclusion: Bone marrow stromal stem cells can differentiate into functional retinal pigmented epithelium cells in a simple, low-cost, high-performance manner over a short period of time. These cells due to expressing the RPELC genes and markers can be used in cell replacement therapy for degenerative diseases including age-related macular degeneration as well as retinitis pigmentosa.

Intravitreal Injection of Anti-vascular Endothelial Growth Factor Agents for Ocular Vascular Diseases: Clinical Practice Guideline.

PURPOSE: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. METHODS: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. RESULTS: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. CONCLUSION: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients.

The Association of Central Corneal Thickness with Ocular and General Parameters in a Community Setting: The Yazd Eye Study.

PURPOSE: To assess central corneal thickness (CCT) and its associations in an adult Iranian population. METHODS: This was a population-based cross-sectional study of adults aged 40-80 years. Eyes with corneal disorders, previous ocular surgery, or trauma were excluded. All subjects underwent complete ophthalmic examination, general health assessment, laboratory tests, and a detailed interview. CCT was measured with an ultrasonic pachymeter. Intraocular pressure (IOP) was measured with Goldmann applanation tonometry. Except for the report on interocular differences in CCT, only one eye of each subject was used for the rest of statistical analyses. RESULTS: The mean age (±SD) of the 1203 participants, who had CCT measurements and met inclusion criteria, was 51.8 ± 8.5 years. The mean CCT was 544 ± 35, 564 ± 28, and 544 ± 36 µm in the eyes of the normal, ocular hypertension, and glaucoma groups, respectively (P = 0.025). In participants without glaucoma, the mean interocular difference in CCT was 9 ± 12 µm. CCT was not significantly associated with age, sex, or some select systemic factors (body mass index, diabetes, hypertension, and renal failure). While controlling for age and sex, CCT was greater in individuals with higher IOPs (P < 0.001), larger vertical or horizontal cup-to-disc ratios (P = 0.044, and P = 0.025, respectively), and hyperopia (P = 0.009). CONCLUSION: In this adult Iranian population, CCT was significantly associated with IOP, cup-to-disc ratio, and the refractive status of eye. CCT outside the normal range of 475-613 µm or with interocular asymmetry greater than 33 µm (6%) should prompt evaluation for potential ocular disorders.

Clinical Practice Guidelines for Prevention, Diagnosis and Management of Early and Delayed-onset Ocular Injuries Due to Mustard Gas Exposure.

PURPOSE: To develop clinical practice guidelines (CPGs) for prevention, diagnosis, treatment and follow-up of ocular injuries caused by exposure to mustard gas. METHODS: The clinical questions were designed by the guideline team. Websites and databases including National Guidelines Clearinghouse, National Institute for Clinical Excellence, Cochrane, and PubMed were searched to find related CPGs and explore possible answers to the clinical questions. Since there were no relevant CPGs in the literature, related articles in Persian and English languages were extracted. Each article along with its level of evidence was summarized. Additionally, hand search was performed by looking the reference list of each article. Consequently, recommendations were developed considering the clinical benefits and side effects of each therapeutic modality. The recommendations were re-evaluated in terms of customization criteria. All recommendations along with the related evidence were scored from 1 to 9 by experts from all medical universities of Iran. The level of agreement among the experts was evaluated by analyzing the given scores. RESULTS: The agreement was achieved for all recommendations. The experts suggested a number of minor modifications which were applied to the recommendations. Finally, CPGs were developed with 98 recommendations under three major domains including prevention of injury, diagnosis and management of the acute and delayed-onset mustard gas ocular injuries. CONCLUSION: Considering the lack of CPGs for the prevention, diagnosis, and management of mustard gas-induced keratitis, these recommendations would be useful to prevent the serious ocular complications of mustard gas and standardize eye care services to the affected individuals.

Distribution of intraocular pressure, central corneal thickness and vertical cup-to-disc ratio in a healthy Iranian population: the Yazd Eye Study.

PURPOSE: To determine the distribution of intraocular pressure (IOP), central corneal thickness (CCT) and vertical cup-to-disc ratio (VCDR) in the healthy Iranian population. METHODS: This population-based, epidemiologic study evaluated Iranian aged 40-80 years, residing in Yazd, Iran, in 2010-2011. Eligible subjects were selected by cluster random sampling. Each participant underwent an interview and ophthalmologic examination including slit lamp examination, Goldmann applanation tonometry, binocular optic disc evaluation, stereoscopic fundus photography, ultrasonic pachymetry and visual field testing. RESULTS: Of 2320 eligible individuals, 2098 subjects (response rate of 90.4%) participated in the study. One eye from 1159 subjects (total of 2262 normal eyes) were randomly selected for the purpose of the study. Mean age was 53.1 ± 9.6 years. Mean IOP, CCT and VCDR were 14.2 ± 2.5 mmHg, 543 ± 37 µm and 0.32 ± 0.14, respectively. Multiple regression analysis showed a significant correlation between IOP and age (regression coefficient = 0.02 per year, p = 0.015), CCT (regression coefficient = 0.02 per micron, p < 0.001), Spherical equivalent (regression coefficient = -0.15 per dioptre, p = 0.0.024) and smoking (regression coefficient = 0.89 higher for smokers, p = 0.009); it also showed a significant correlation between CCT with spherical equivalent (regression coefficient = 3.6 per dioptre, p = 0.002) and IOP (regression coefficient = 3.6 per mmHG, p < 0.001). There was no significant correlation with VCDR. CONCLUSIONS: Mean IOP, CCT and VCDR were 14.2 ± 2.5 mmHg, 543 ± 35 µm and 0.32 ± 0.14, respectively, in healthy Iranians that is different from other ethnicities. It seems advisable to pay attention to ethnicity for interpretation of each person's variables.

Diabetic Retinopathy Clinical Practice Guidelines: Customized for Iranian Population.

PURPOSE: To customize clinical practice guidelines (CPGs) for management of diabetic retinopathy (DR) in the Iranian population. METHODS: Three DR CPGs (The Royal College of Ophthalmologists 2013, American Academy of Ophthalmology [Preferred Practice Pattern 2012], and Australian Diabetes Society 2008) were selected from the literature using the AGREE tool. Clinical questions were designed and summarized into four tables by the customization team. The components of the clinical questions along with pertinent recommendations extracted from the above-mentioned CPGs; details of the supporting articles and their levels of evidence; clinical recommendations considering clinical benefits, cost and side effects; and revised recommendations based on customization capability (applicability, acceptability, external validity) were recorded in 4 tables, respectively. Customized recommendations were sent to the faculty members of all universities across the country to score the recommendations from 1 to 9. RESULTS: Agreed recommendations were accepted as the final recommendations while the non-agreed ones were approved after revision. Eventually, 29 customized recommendations under three major categories consisting of screening, diagnosis and treatment of DR were developed along with their sources and levels of evidence. CONCLUSION: This customized CPGs for management of DR can be used to standardize the referral pathway, diagnosis and treatment of patients with diabetic retinopathy.

Depression and Hypothyroidism in a Population-Based Study of Iranian Women.

BACKGROUND: Recent biochemical and physiological investigations have focused on the fundament of mood disorders in thyroid dysfunction. The present study aimed to address depressive disorder in a sample of Iranian hypothyroid women compared to euthyroid individuals. METHODS: Thirty consecutive hypothyroid female patients aged 25 to 40 years who referred to the Endocrinology and Metabolism Clinic at Rasoul-e-Akram Hospital in Tehran within a four-month period in 2015 were assessed. Thirty healthy euthyroid subjects matched for sex, age, and educational level were selected as the control. For assessment of depression status, Depression Anxiety Stress Scale-21 (DASS-21) was employed. RESULTS: The study showed higher mean depression score in hypothyroid patients when compared to euthyroid ones (13.8 ± 9.5 versus 5.8 ± 5.2, p = 0.010). No significant association was revealed between mean depression score and patients' education level (p = 0.627), age (p = 0.967), occupation status (p = 0.211), and marital status (p = 0.556). CONCLUSION: Hypothyroid women are predisposed to depressive symptoms independent of their baseline demographic and socioeconomic characteristics.

The Impact of Congenital Strabismus Surgery on Quality of Life in Children.

PURPOSE: To assess quality of life (QOL) in children undergoing strabismus surgery. METHODS: This prospective cohort study included 87 children (including 41 boys, 47.1%) with mean age of 8.7 ± 4.1 years at three academic eye hospitals in Tehran. A modified version of the RAND Health Insurance Study QOL questionnaire was filled based on interviews with parents before and three months after surgery. The questionnaire consisted of 36 Likert scale items ranging in score from 0 to 100, with higher scores representing better function. Relevant items were averaged together and categorized into 11 distinct QOL dimensions. RESULTS: The majority of QOL dimensions improved after strabismus surgery including functional limitation (92.36 ± 16.78 vs. 82.15 ± 20.92, P < 0.01), anxiety (68.61 ± 18.15 vs. 60.28 ± 19.19, P < 0.01), depression (82.31 ± 16.42 vs. 72.36 ± 17.72, P < 0.01), positive well-being (73.33 ± 14.69 vs. 70.56 ± 15.96, 0.048), social relations (79.43 ± 11.52 vs. 68.69 ± 30.98, 0.002), general health perception (76.4 ± 16.48 vs. 67.36 ± 18.9, P < 0.01), resistance/susceptibility (79.72 ± 13.4 vs. 71.02 ± 14.58, P < 0.01), satisfaction with development (73.81 ± 16.07 vs. 70.07 ± 14.98, P = 0.006), and eye alignment concerns (75.44 ± 15.89 vs. 53.14 ± 26.61, P < 0.01). Only self-reported prior health (71.73 ± 15.9 vs. 72.78 ± 15.29, P = 0.33) and parent-child closeness (72.92 ± 15.82 vs. 72.5 ± 17.99, P = 0.73) did not significantly improve. The amount of ocular realignment (more vs. less than 20 prism diopters [PD]) had a direct correlation with improvement in subscales of satisfaction with development (0.019) and eye alignment concerns (0.028). CONCLUSION: Strabismus surgery positively impacts physical and psychosocial function in children. Children with a greater amount of correction experienced more QOL improvement after surgery.

Histological and Electrophysiological Changes in the Retinal Pigment Epithelium after Injection of Sodium Iodate in the Orbital Venus Plexus of Pigmented Rats.

PURPOSE: To characterize histopathologic and electroretinographic (ERG) changes in the retina of pigmented rats injected with sodium iodate in order to establish a model of retinal degeneration for future cell therapy studies. METHODS: In 50 male pigmented rats weighing 250-300 grams, NaIO3 was injected into the left orbital venous plexus at 40 and 60 mg/kg doses (25 eyes in each group). Fourteen rats received phosphate buffered saline (PBS) injection in their left orbital plexus and were considered as the sham-control group. Histopathologic and ERG studies were performed at baseline and on days 1, 7, 14 and 28 after the injections. RESULTS: Progressive retinal pigment epithelial (RPE) changes were observed from the first day of injection in both the 40 and 60 mg/kg study groups in a dose dependent manner. These changes manifested as loss of melanin pigment and accumulation of lipofuscin in RPE cells with subsequent cell death and patchy loss of RPE cells (in flat mounts), as well as thinning of the outer nuclear layer and later the inner nuclear layer in the succeeding days. ERG showed a progressive and significant decrease in a- and b- wave amplitudes in both case groups relative to baseline values and the controls (P < 0.05). CONCLUSION: NaIO3 injection into the retrobulbar venous plexus of pigmented rats can result in significant and progressive damage to the RPE and subsequently to the neuroretina of the injected eye, and may serve as a model of retinal degeneration.

Perioperative prophylaxis for endophthalmitis after cataract surgery in iran.

PURPOSE: To describe prophylactic patterns employed against endophthalmitis after cataract surgery in Iran. METHODS: This cross-sectional study included 486 ophthalmologists filling in a self-administered questionnaire during the 20(th) Annual Congress of the Iranian Society of Ophthalmology in December 2010, Tehran, working in both private and academic medical centers. Prophylactic measures used preoperatively, intraoperatively and postoperatively and self-reported rates of endophthalmitis were assessed as the main outcome measurements. RESULTS: In the preoperative phase, 75.5% of surgeons used povidone-iodine in the conjunctival sac and 71.4% of them did not use antibiotics. The rate of intraoperative prophylaxis was 61.9% either in the form of intracameral antibiotics or subconjunctival injection (mostly cephazolin or gentamicin). Only 7.8% of participants used intracameral cephalosporins. Postoperative antibiotics [mostly chloramphenicol (57%) and ciprofloxacin (28%)] were used by 94.2% of surgeons. On average, ten years of practice were required to observe one case of endophthalmitis. CONCLUSION: The surgeons in present setting used various prophylactic regimens against endophthalmitis after cataract surgery. Setting a local and evidence-based clinical practice guideline seems necessary.

Customized Clinical Practice Guidelines for Management of Adult Cataract in Iran.

PURPOSE: To customize clinical practice guidelines (CPGs) for cataract management in the Iranian population. METHODS: First, four CPGs (American Academy of Ophthalmology 2006 and 2011, Royal College of Ophthalmologists 2010, and Canadian Ophthalmological Society 2008) were selected from a number of available CPGs in the literature for cataract management. All recommendations of these guidelines, together with their references, were studied. Each recommendation was summarized in 4 tables. The first table showed the recommendation itself in clinical question components format along with its level of evidence. The second table contained structured abstracts of supporting articles related to the clinical question with their levels of evidence. The third table included the customized recommendation of the internal group respecting its clinical advantage, cost, and complications. In the fourth table, the internal group their recommendations from 1 to 9 based on the customizing capability of the recommendation (applicability, acceptability, external validity). Finally, customized recommendations were sent one month prior to a consensus session to faculty members of all universities across the country asking for their comments on recommendations. RESULTS: The agreed recommendations were accepted as conclusive while those with no agreement were discussed at the consensus session. Finally, all customized recommendations were codified as 80 recommendations along with their sources and levels of evidence for the Iranian population. CONCLUSION: Customization of CPGs for management of adult cataract for the Iranian population seems to be useful for standardization of referral, diagnosis and treatment of patients.

Knowledge and awareness of age related eye diseases: a population-based survey.

PURPOSE: To determine general awareness and knowledge about cataracts, glaucoma and diabetic retinopathy (DR), as common avoidable causes of blindness in an Iranian population. METHODS: This cross-sectional population-based survey was performed on residents over 45 years of age in Tehran. The sampling frame was the list of all landline phone numbers registered by the Telecommunications Center of Iran, through which systematic random sampling was performed. Data was collected by phone-call interviews and completing a semi-structured questionnaire. Awareness was defined as whether the respondent had ever heard of the disease. Knowledge was assessed by realizing different aspects of each disease. RESULTS: Of a total of 1,084 eligible people including 574 (52.9%) women and 510 (47.1%) men were included and 957 subjects (response rate, 88.3%) completed the interview. Awareness regarding glaucoma, cataract and DR was 46.6% (95% confidence interval [CI]:43.4 -49.8%), 82.9% (95% CI: 80.5 -85.3%) and 86.2% (95% CI: 84-88.4%). In addition, 19.2% (95% CI: 16.7 -21.7%), 57.3% (95% CI: 54.2-60.4%) and 72% (95% CI: 69.2 -74.8%) of respondents could give at least a basic definition of the mentioned diseases, respectively. Only 22.6% (95% CI: 20-25.2%) and 41.6% (95% CI: 38.5-44.7%) realized glaucoma and DR as a treatable condition; in contrast, 77.2% (95% CI: 74.5-79.9%) categorized cataract as treatable. Only 19% and 7.1% knew that DR and glaucoma may commence without any apparent symptoms. CONCLUSION: Compared with cataract and DR, most participants had limited information about glaucoma. In addition, few of the respondents were familiar with the initial symptoms of DR and glaucoma.

Profile of cataract surgery in Varamin Iran: a population-based study.

BACKGROUND: Cataract is the most popular cause of blindness. This study addresses some aspects of cataract surgery in an Iranian population. DESIGN: A cross-sectional study. PARTICIPANTS: 3000 adults over 50 in Varamin district. METHODS: Cataract surgical coverage was defined as the proportion of (pseudo) aphakic eyes of all operable and operated eyes with cataract. If there was obvious lens opacity in either or both eyes in combination with best corrected visual acuity less than 6/18, the person was asked why the operation for cataract was not done to find out about barriers of cataract surgery. Outcomes of cataract surgery were categorized as good, intermediate and poor using presenting visual acuity which were defined as visual acuity ≥ 6/18, 6/60 ≤ visual acuity < 6/18 and visual acuity < 6/60, respectively. MAIN OUTCOME MEASURES: Cataract surgical coverage, barriers and outcomes of cataract surgery. RESULTS: Out of 5638 examined eyes, 526 eyes (9.3%) had history of cataract surgery. 156 subjects (45.7%) had a unilateral and 185 subjects (54.2%) had bilateral operated eyes. Cataract surgical coverage was 66.4% in visually impaired eyes (visual acuity < 6/18), 90.4% in blind eyes (visual acuity < 3/60), 80.5% in visually impaired persons and 97.6% in blind persons. Cataract surgery in the majority of eyes (71.9%) had a good visual outcome. The main barrier of cataract surgery was unawareness of treatment. CONCLUSION: Overall, the cataract services in the studied population were acceptable, although it should be improved, to achieve vision 2020 objectives.

Prevalence of refractive errors; the yazd eye study.

PURPOSE: To determine the prevalence of refractive errors in Yazd, central Iran. METHODS: This population-based study was performed in 2010-2011 and targeted adults aged 40 to 80 years. Multi-stage random cluster sampling was applied to select samples from urban and rural residents of Yazd. Manifest refraction, visual acuity measurement, retinoscopy and funduscopy were performed for all subjects. Myopia, hyperopia, astigmatism and anisometropia were defined as spherical equivalent (SE) <-0.50 diopters (D), SE >+0.50 D, cylindrical error >0.5 D and SE difference ≥1 D between fellow eyes, respectively. RESULTS: From a total of 2,320 selected individuals, 2,098 subjects (90.4%) participated out of which 198 subjects were excluded due to previous eye surgery. The prevalence (95% confidence interval) for myopia, hyperopia, astigmatism, anisometropia, -6 D myopia or worse, and 4 D hyperopia or worse was 36.5% (33.6-39.4%), 20.6% (17.9-23.3%), 53.8% (51.3-56.3%), 11.9% (10.4-13.4%), 2.3% (1.6-2.9%) and 1.2% (0.6-1.8%), respectively. The prevalence of hyperopia, astigmatism and anisometropia increased with age. The prevalence of myopia was significantly higher in female subjects. The prevalence of with-the-rule, against-the-rule and oblique astigmatism was 35.7%, 13.4% and 4.6%, respectively. The prevalence of against-the-rule astigmatism increased with age (P<0.001); with-the-rule astigmatism was more common in women (P=0.038). CONCLUSION: More than half of the study population had refractive errors; the prevalence of myopia and astigmatism was higher than earlier studies in Iran. Since refractive errors are a major cause of avoidable visual impairment, their high prevalence in this survey is important from a public health perspective.

A population-based survey of the prevalence and types of glaucoma in central Iran: the Yazd eye study.

PURPOSE: To describe the prevalence and types of glaucoma in Yazd, central Iran. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Iranian adults aged 40 to 80 years, residing in Yazd, Iran, in 2010 and 2011. METHODS: Eligible samples were selected using cluster random sampling. Each participant underwent an interview and ophthalmologic examinations, including refraction, determination of uncorrected and best-corrected visual acuity, slit-lamp biomicroscopy, Goldmann applanation tonometry, gonioscopy, dilated fundus examination, central corneal thickness measurement, visual field testing, and stereoscopic fundus photography. MAIN OUTCOME MEASURES: Prevalence of different types of glaucoma. RESULTS: Of 2320 eligible individuals, 2098 (response rate, 90.4%) participated in the study and 1990 completed all evaluations for glaucoma diagnosis. Overall, 47 persons (2.4%) were categorized with ocular hypertension, 32 persons (1.6%) were categorized with primary angle-closure suspect (PACS), and 16 persons (0.8%) were categorized with primary angle closure (PAC). The total number of subjects with glaucoma was 87 (4.4%; 95% confidence interval, 3.3-5.4), consisting of primary open-angle glaucoma (POAG, 3.2%, including high-tension glaucoma [1.7%] and normal-tension glaucoma [NTG], 1.5%]), primary angle-closure glaucoma (PACG, 0.4%), pseudoexfoliation glaucoma (0.4%), and other secondary glaucomas (0.4%). The mean age of subjects with glaucoma was 63.3 ± 11 years, and 57.5% of them were female. Seventy-eight individuals (89.7%) were unaware of their disease. Positive family history of glaucoma was present in 6.9% of glaucoma subjects. CONCLUSIONS: The prevalence of glaucoma in Yazd (4.4%) is comparable to that in other population-based studies in Asia, with POAG accounting for the majority of cases. Most affected subjects were unaware of their disease. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Prevalence of second-eye cataract surgery and time interval after first-eye surgery in Iran: a clinic-based study.

PURPOSE: To determine the prevalence of second-eye senile cataract surgery (SECS) as a proportion of all senile cataract surgeries and the trend in the interval between first and second cataract operations in a main referral and academic eye hospital. MATERIALS AND METHODS: In this cross-sectional study, a list of patients who underwent senile cataract surgery over four consecutive years (2006-2009) was retrieved from hospital computer-based records as the sampling frame. With a systematic random method, 15% of records were selected (1,585 out of 10,517 records). RESULTS: First- and second-eye operations were performed in 1,139 (71.9%; 95% confidence interval [CI], 69.5-74.1) and 446 eyes (28.1%; 95% CI, 25.9-30.35), respectively. The proportion of SECS procedures increased from 24.3% in 2006 to 33.4% in 2009 (P = 0.017). The median (interquartile range) interval between the two operations was 9 (4-24) months, which remained stable during the study period. The SECS rate was 10.4% higher (P = 0.01) and the time interval was 13 months shorter (P = 0.007) in patients who underwent phacoemulsification than extracapsular cataract extraction. CONCLUSION: The number of cataract operations in this tertiary eye care setting increased 1.5 fold over the study period. The proportion of second-eye operations also rose from 1/4 to 1/3 during the same time.

The Yazd Eye Study-a population-based survey of adults aged 40-80 years: rationale, study design and baseline population data.

PURPOSE: To describe the rationale, methodology and baseline data of the Yazd Eye Study, a study in the urban and rural areas of Yazd, a district in the center of Iran. METHODS: This population-based cross-sectional study included adults aged 40-80 years from the non-institutionalized population of the Yazd district, in 2010-2011. Using multi-stage, systematic cluster random sampling and a probability proportional to size strategy, 58 clusters of 40 subjects were selected from 251 clusters in different enumeration areas. A detailed interview and eye examination were performed for each eligible participant. The eye examination included refraction testing, uncorrected and best corrected visual acuity testing, slit lamp biomicroscopy, Goldmann applanation tonometry, gonioscopy, dilated fundus examination, visual field, determination of central corneal thickness, and stereoscopic fundus photography. General health assessments and laboratory tests including hemoglobin, hematocrit, glycosylated hemoglobin, fasting blood sugar, serum lipids, and urine albumin to creatinine ratio were also performed to assess anthropometric and systemic risk factors. RESULTS: Of 2320 eligible individuals, 2098 (response rate 90.4%) participated in the study. The mean ± standard deviation age of participants was 54.1 ± 10.0 years, and included 994 men (47.4%) and 1104 women (52.6%). Most participants lived in urban regions (89.2%) and were younger than 60 years old (72.0%). Among the participants, 20.1% were illiterate, and 40.9%, 28.0%, and 11.0% had primary, secondary and college or university level education, respectively. CONCLUSION: This study is expected to provide an estimate of the prevalence and risk factors of major eye diseases and normal eye indices in the Yazd district.

The gender issue in congenital and developmental cataract surgery.

PURPOSE: To describe the demographic pattern of congenital cataract surgery at a referral ophthalmology center in Iran and to evaluate any possible difference between the genders. METHODS: Subjects aged 15 years or less scheduled for cataract surgery were enrolled in this cross-sectional study. Data was retrieved from the electronic medical records according to the ICD-10 coding system. Age and proportion of operations by sex were the main parameters of interest. We employed analysis of covariance to compare age at surgery and logistic regression to obtain the trend for the number of cataract procedures in boys and girls. RESULTS: Overall, 314 congenital cataract procedures were performed during the study period, 55 (17.5%) of which were related to second eye surgery. Operated eyes belonged to male subjects in 172 (54.8%) cases and female subjects in 142 (45.2%) cases. Mean age at operation for both first and second eyes was 3.2±3.0 years overall, and 3.1±2.9 versus 3.4±3.0 years in girls and boys, respectively (P= 0.62). Surgery was performed before one year of age in 33.2% and before 5 years in 75% of cases. Among patients undergoing second eye surgery, girls presented significantly later than boys (at 4.2±3.3 vs. 2.6±1.7 years, P= 0.012). CONCLUSION: The rate of congenital/infantile cataract surgery in boys was almost 10% higher than girls. We observed a significant difference only regarding age at second eye surgery which comprised 17.5% of all operations. One third and two thirds of the procedures were performed under the age of one and five years, respectively.

Vision Related Quality of Life in Myopia; Photorefractive Keratectomy versus Nonsurgical Optical Correction.

PURPOSE: To compare quality of life (QOL) in myopic patients who underwent photorefractive keratectomy (PRK) with that of myopic spectacle or contact lens users. METHODS: This observational comparative study was performed on 102 low to moderate myopic patients who had undergone PRK at least 6 months ago and 106 myopic spectacle or contact lens wearers. Vision related QOL and its correlation with demographic variables, visual acuity and refractive status were compared between the two groups. QOL was measured using a validated translated version of the Visual Function Questionnaire (VFQ-25) which contains 25 questions in 12 subscales with a total score of zero to 100. RESULTS: Mean total QOL score was 97.0±4.4 and 86.1±10.7 in PRK and nonsurgical groups respectively [mean difference (d)=11, P<0.001]. The difference was independent of age, sex, education or marital status (P>0.05). Overall, 10 out of 12 QOL subscales were significantly higher in the PRK group (P<0.001) especially general vision (d=23.8), general health (d=22.2), driving (d=19.3), role difficulties (d=14.6), distance activities (d=13.8) and mental health (d=13.7). Only color vision (d=1.6, P>0.9) and ocular pain (d=3.1, P=0.3) were not significantly different between the study groups. CONCLUSION: Correction of myopia using PRK is associated with higher QOL scores in most subscales as compared to spectacle or contact lens wear.