Purpose: To evaluate the surgical outcome and refractive status after triple procedure in patients with Fuchs’ dystrophy combined with cataract.
Patients and Methods: Thirty four consecutive eyes of 29 patients with coexisting cataract and Fuchs’ dystrophy entered the study. All patients underwent phacoemulsification and IOL implantation through a temporal incision followed by Descemet stripping automated endothelial keratoplasty  (DSAEK). Patients were assessed regarding best corrected visual acuity (BCVA), refractive cylinder and refractive spherical equivalent before surgery, after 3 months and 3 years of follow-up.
Results: The mean BCVA was 0.87 ± 0.448 logMAR pre-operatively which increased to 0.29 ± 0.164 logMAR at three months (p <0.001), and 0.19 ± 0.129 at three years (p <0.001). The mean preoperative spherical equivalent was 0.758 ± 2.384 which reached 0.32 ±0.55 (p <0.001) and 0.24 ± 0.46 (p <0.001) three months and three years after the simultaneous surgery, respectively. The mean preoperative cylinder was -1.43 ± 1.141 which reached -0.87 ±0.55 (p <0.001) and -0.69 ± 0.39 (p <0.001); three months and three years after the simultaneous surgery, respectively.
Conclusion: Refractive and visual outcomes after triple surgery are favorable in terms of BCVA, refractive cylinder and refractive spherical equivalent. Therefore, triple procedure might be recommended in older patients due to its rapid visual rehabilitation.

Keywords: Descemet stripping automated endothelial keratoplasty; phacoemulsification; best corrected visual acuity; refractive cylinder; spherical equivalent.

Purpose: The aim of this study was to assess the effects of corneal collagen cross-linking (CXL) on uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), subjective refraction, corneal irregularity, anterior chamber depth (ACD), corneal thickness, and k-readings.

Patients and Methods: Eighty-four eyes of 44 patients with keratoconus  were treated using corneal collagen cross-linking. UCVA, BCVA, and subjective refraction were evaluated preoperatively as well as 3 months and 4 years after treatment and corneal Orbscan results were evaluated preoperatively and 4 years after treatment. Comparisons were made using paired sample t tests and a P values less than 0.05 were considered statistically significant.

Results: There was a significant reduction in the mean thickness of the thinnest point of the cornea from 462.24 ± 46.95 µm preoperatively to 454.36 ± 55.32 µm (P < 0.05) at the last follow-up. The mean maximum and mean minimum curvature values reduced significantly from 48.00  ± 4.02 D and 45.03  ± 2.88 D preoperatively to 47.56  ± 3.75 D (P < 0.05) and 44.64 ± 2.94 D (P < 0.001), respectively at the last follow-up, whereas the UCVA (P = 0.309), BCVA (P = 0.594), subjective spherical equivalent (P = 0.591), subjective cylindrical refraction (P = 0.522), irregularity at the 3 mm (P = 0.338) and 5 mm (P = 0.915) zone of the cornea, anterior chamber depth (P = 0.072), and central corneal thickness (P = 0.203) remained unchanged. There were no significant postoperative complications.

Conclusion: Based on our results, treatment  of progressive keratoconus with CXL can effectively stabilize UCVA, BCVA, subjective spherical equivalent, subjective cylindrical refraction, corneal irregularity, central corneal thickness and anterior chamber depth while reducing keratometry.

Keywords: Cornea, Keratoconus, Collagen Crosslinking.

Purpose: To evaluate the efficacy of Wavefront-guided photorefractive keratectomy (PRK) for correction of residual refractive
error after intrastromal corneal ring segments (ICRS) insertion for treatment of keratoconus.
Patients and Methods: In this prospective case series five eyes of 5 keratoconus patients who had previous ICRS implantation (four Intacs TM and one Keraring), underwent Wavefront-guided PRK to correct residual refractive error.
Results: Three months postoperatively, the mean spherical equivalent (SE) improved from 2.07 ± 1.38 Diopter to - 0.87 ± 0.54 Diopter. Four out of 5 eyes were within ± 1.00 D of Plano refraction. Three eyes had UCVA of 20/30 or better (all eyes; 20/40 or better). After 6 months, the mean SE was - 0.75 ± 0.50 Diopter and all eyes were within ± 1.00 D of Plano refraction. UCVA was 20/20 in 2 eyes, 20/30 or better in 2 eyes and 20/40 in one eye. One patient lost one line of BCVA.
Conclusion: This case series showed that wavefront-guided PRK might be an effective procedure for correction of residual refractive error after ICRS insertion in keratoconus patients. Significant improvement in UCVA was seen in all cases after PRK without any complications and haze.

Purpose: To evaluate the long-term outcome of limbal stem cell transplantation for management of total limbal stem cell deficiency due to chemical burn.
Patients and Methods: In this retrospective cross sectional study; records of patients with history of severe (grade III to IV) chemical burns who underwent limbal stem cell transplantation in Labbafinejad Medical Center, Tehran, Iran between 2006 and 2016 were reviewed and data including demographic characteristics, visual acuity, surgical interventions and outcomes were reported.
Results: Fifty eyes of fifty patients with a history of conjunctival limbal autograft (N = 24) or keratolimbal allograft (N = 26) with at least 12-months follow-up were included. The overall 1-year and 5-year survival was 100 % and 84.1 % for conjunctival limbal autograft and 80.4 % and 40 % for keratolimbal allograft, respectively (P = 0.037). Corneal transplantation was performed after limbal stem cell transplantation in 20 eyes after conjunctival limbal autograft and 25 eyes after keratolimbal allograft. The 1-year and 5-year corneal graft survival was 93.3 % and 63.8 % after conjunctival limbal autograft and 92 % and 38.4 % after keratolimbal allograft (P = 0.005 for five year survival). There was a significant improvement in LogMAR BCVA (1.79 versus 2.17, P < 0.001) in all patients with no statistically significant difference between the two groups.
Conclusion: Severe chemical burn is associated with significant ocular morbidity and long-term prognosis is poor. Graft survival rate was significantly better in conjunctival limbal autograft compared to keratolimbal allograft when comparing the Long-term outcome of limbal stem cell transplantation for management of total limbal stem cell deficiency due to chemical burn.

Keywords: Limbus Cornea, Stem Cell, Transplantation, Cornea, Eye Burns

Purpose: To evaluate the prevalence of accommodative insufficiency in a student population from Iran.

Patients and Methods: This cross-sectional study was performed on 596 eyes from 298 participants (157 males, 141 females) in age range of 18 to 29 years among students from Iran University of Medical Sciences, Tehran, Iran, between 2014 and 2015. The amplitude of accommodation among volunteers in this study was evaluated using the Donder's push up method. Then, the minimum normal amplitude of accommodation for a given age was estimated by Hofstetter formula (15 - 0.25 * age in years), and then the prevalence of accommodative insufficiency among the study population was determined according to this calculations.
Results: We found the prevalence of accommodative insufficiency to be 7.2% in the study population. The prevalence of accommodative insufficiency was 4.1% and 7.25% among males and females respectively (P < 0.001).
Conclusion: The prevalence of accommodative insufficiency in our study population was less than previous studies among children, which might be explained by the role of natural selection (people with accommodative disorders might have less chance of excelling in education and entering higher education institutes than patients without this disorder). We also found a statistically significant higher prevalence of accommodative insufficiency among female college aged students compared to male students.

Keywords: Accommodation, insufficiency, prevalence, eye, Iran.

Abstract

Keratoconus is a common corneal ectatic disorder which affects approximately 1 in 2,000 people. The traditional treatments for keratoconus are the use of inserts, deep anterior lamellar keratoplasty (DALK) and anterior lamellar keratoplasty (ALKP). Corneal cross-linking is a relatively new minimally invasive therapeutic approach for treatment of progressive keratoconus, which increases the structural integrity of the cornea. In corneal cross-linking the production of oxygen free radicals by ultraviolet A (UVA) light increases the biomechanical strength of cornea while riboflavin acts as a photo synthesizer for production of oxygen free radicals by UVA. Treatment of progressive keratoconus is the most widespread use of cross-linking technique. In the present manuscript we will summarize different aspects of the utilization of cross-linking in treatment of corneal keratoconus. 

Keywords: Corneal Cross-linking; Treatment; Progressive; Keratoconus

Abstract

Retinopathy of prematurity is a vaso-proliferative retinal disorder occurring in preterm infants. With the increase in the survival of preterm infants, retinopathy of prematurity has become a major cause of childhood blindness worldwide. In this brief review the main aspects of this disease including pathogenesis, classification, epidemiology, screening and treatment are discussed.

Keywords: Retinopathy of prematurity; Preterm, Incidence, Treatment, Classification, Screening.

Headache is a common sign during optic neuritis. These headaches are usually one sided and worsen when the affected eye moves. The aim of the present manuscript is to report severe headache in a patient with optic neuritis and history of migraine headache initiated by flash stimulation of affected eye during visual evoked potential (VEP) recording.  Based on our findings we suggest that patients with a history of migraine headache should be informed about possible headache before VEP recording using flash stimulus.  

Keywords: Headache, optic neuritis, visual evoked potential, flash stimulation.