Recurrent Peripheral Stromal Keratitis Following Corneal Collagen Cross-linking: A Case Report.

PURPOSE: Corneal collagen cross-linking (CXL) has become the standard initial intervention in eyes with progressive keratoconus (KC) that have not undergone keratoplasty. The prolonged exposure of the de-epithelialized cornea predisposes it to adverse complications, such as microbial keratitis and melting. Herein, we report a case of bilateral recurrent peripheral stromal keratitis following CXL. CASE REPORT: We present a 29-year-old woman who complained of ocular redness and discomfort in both eyes for 4 months, and had undergone bilateral CXL 10 months before. The best spectacle corrected visual acuity (BSCVA) was 60/200 in the right and 80/200 in the left eye. Both eyes showed moderate conjunctival hyperemia, dilation, and engorgement of the perilimbal episcleral vessels. There was a peripheral corneal stromal infiltration with thinning, and an overlying epithelial defect in the right eye with a lucid interval from the limbus. She was treated with lubricating eye drops and ointments and topical corticosteroids every 4 hours for 2 weeks then slowly tapered off. Afterwards, she experienced multiple recurrences in both eyes, which were successfully managed with topical corticosteroids and lubricants. After 2 years, her BSCVA was 20/30 with -3.00-5.50 * 90 in the right eye and 20/40 with -4.00-4.50 * 90 in the left. CONCLUSION: Although CXL is a safe method, studies with longer follow-ups are needed to investigate the risk of rare complications.

Fuchs heterochromic iridocyclitis-associated glaucoma: a retrospective comparison of primary Ahmed glaucoma valve implantation and trabeculectomy with mitomycin C.

Background: The aim of this study was to compare the safety and efficacy of primary trabeculectomy with mitomycin C and Ahmed glaucoma valve (AGV) implantation in patients with Fuchs heterochromic iridocyclitis (FHIC)-related glaucoma, a rare complication of an uncommon form of uveitis. Methods : In this retrospective comparative case series, 26 FHIC-associated glaucoma patients received trabeculectomy (n=12) or an AGV (n=14). Primary outcome measures were surgical success, defined as intraocular pressure (IOP) ≤21 mmHg, decreasing ≥20% from baseline, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity (BCVA), and IOP. Results: The follow-up was 34.0±17.7 months in patients that received trabeculectomy and 33.4±18.6 months in AGV (P= 0.837). The cumulative probability of success rate was 41.7% for trabeculectomy and 85.7% for AGV, with no significant difference in complications (P>0.05). The IOP in patients that received trabeculectomy dropped from 23.4±3.3 mmHg to 21.6±5.2 mmHg at the final visit (P= 0.041). In patients that received AGV, the IOP decreased from 24±7.8 to 17.1±2.6 mmHg (P= 0.003). The number of glaucoma medications at baseline were 3.3±0.5 in those that received trabeculectomy and 3±0.6 in those that received AGV (P=0.233), and decreased to 2.4±1.0 (P=0.008) and 1.7±0.6 (P=0.002), respectively. BCVA was equal in both groups and did not change (P>0.05). Conclusion: Primary AGV had a higher success rate than trabeculectomy, with patients also needing fewer medications for the management of FHIC-associated glaucoma.

Hypothyroidism among pediatric patients with type 1 diabetes mellitus, from patients' characteristics to disease severity.

We performed this study to evaluate the associations of hypothyroidism with clinical severity and the occurrence of diabetic ketoacidosis (DKA) at initial diagnosis among pediatric patients with type 1 diabetes mellitus (T1DM). 330 children with T1DM who referred to Diabetes Clinic were enrolled. The medical records were e valuated and a blood sample was drawn from patients for measuring thyroid function and antibodies, blood glucose, and glycated hemoglobin (HbA1C) levels. Hypothyroidism was detected in 9.6% of children with T1DM and was associated with higher rates of DKA (OR = 3.15, 95%CI = 1.48-6.71) and younger age at initial diagnosis (7.3 ± 3.2 vs. 10.1 ± 2.5, p = 0.04), higher levels of HbA1C upon enrolment (9.8 ± 2.2 vs. 8.8 ± 1.9, p = 0.02) and the requirement for higher insulin doses to control the disease (0.9 ± 0.42 vs. 0.81 ± 0.2, p = 0.03) compared to children with T1DM and normal thyroid function. Additionally children with T1DM and hypothyroidism had significantly higher rates of anti-TPO antibodies (p < 0.001), consanguinity in their parents (p =0.01), and family history of diabetes mellitus (p = 0.02) in their first degree relatives. In conclusion autoimmune hypothyroidism is prevalent among children with T1DM and is associated with a more aggressive disease at initial presentation, poorly controlled T1DM, and requirement for higher Insulin doses for controlling the disease.

Prevalence of anemia and correlated factors in the reproductive age women in rural areas of tabas.

OBJECTIVE: To find out the prevalence and relationship of anemia in reproductive age women in rural area of Tabas, center of Iran. Iron deficiency anemia is the most common nutritional problem, affecting about 41.8% of pregnant and 30.2% of non-pregnant women worldwide. MATERIALS AND METHODS: A cross-sectional study was conducted on the random sample of 382 reproductive age women in rural areas of Tabas in March 2010. Independent sample t-test, one way analysis of variance (ANOVA) and logistic regression were applied for the data analysis. RESULTS: The obtained data revealed a total response rate of 13.8% for prevalence of anemia, while 14.5% and 5.9% belonged to non-pregnant and pregnant participants, respectively. Low socioeconomic status (odds ratio 3.35) and high parity index (odds ratio 2.31) were associated with higher prevalence of anemia. CONCLUSION: Although this study was conducted in a rural area of Tabas, where their average incomes were lower than average income of major cities in Iran, the prevalence of anemia was lower than the rate reported in previous studies carried out in other locations of Iran, even in high risk (pregnant women) groups.