Journal of Ophthalmic and Optometric Sciences

Purpose: To compare the effects on central corneal endothelial cells measured by confocal microscopy after photorefractive keratectomy (PRK) with mitomycin C (MMC) using mechanical and tetracaine-assisted methods.
Patients and Methods: In this prospective, randomized, comparative study, 44 patients (88 eyes) with myopia of up to -6.00 diopters were enrolled. Each patient's right eye was randomly assigned to either the tetracaine-assisted or the mechanical debridement group, with the left eye assigned to the other method. Preoperative and 3-month postoperative assessments were conducted using confocal microscopy. These assessments measured epithelial thickness, the number of keratocytes in the anterior, mid, and posterior stroma, and the characteristics of central corneal endothelial cells. These characteristics included cell density, mean cell area, polymegathism, and hexagonality.
Results: No statistically significant differences were observed between the two groups considering the mean epithelial thickness at the 3-month follow-up. Additionally, there were no statistically significant differences in the central corneal endothelial cells characteristics including the mean cell density, mean cell area, mean hexagonality, or mean polymegathism. The density of mid and posterior stromal keratocytes remained unchanged compared to baseline in both groups. However, a significant decrease in anterior stromal keratocyte density was observed in both groups three months after surgery, with no significant difference between the two debridement methods.
Conclusion: The effects of PRK with MMC using mechanical or tetracaine-assisted epithelial debridement methods on central corneal endothelial cells are similar. Additionally, both techniques lead to comparable reductions in stromal keratocyte density in anterior stromal layer.

Purpose: To evaluate the patterns of refractive errors among patients who visited Ibn Al Haytham hospital, Baghdad, Iraq, from January 2023 to December 2023.
Patients and Methods: This cross-sectional observational study was conducted between January 2023 and December 2023. Participants aged 18 and above were selected using random sampling from individuals referred for eye care at the hospital during the study period. Data were collected using a standardized checklist. Visual acuity tests with a Snellen chart, and refractive error measurements using an autorefractometer were performed.
Results: Of the 309 participants included in the study, myopia was the most prevalent condition, affecting 63.8 % (n = 197), while hyperopia was present in 36.2 % (n = 112). Additionally, 40.1 % (n = 124) of participants had astigmatism, and 34.63 % (n = 107) had abnormal visual acuity. The distribution of refractive errors by gender showed that myopia (68.02 %, P = 0.001) and astigmatism (69.35 %, P = 0.016) were more prevalent in female participants. Job status was also associated with the distribution of refractive errors (P = 0.040) and astigmatism (P = 0.002). Finally, family history showed a significant association with the pattern of refractive errors among participants (P = 0.035).
Conclusion: The study results highlight significant variations in the prevalence and patterns of refractive errors among patients at Ibn Al Haytham hospital, Baghdad, Iraq, with myopia being the most common condition. Gender, job type and familial history were found to have significant associations with different types of refractive errors.

Purpose: This study aimed to compare the visual evoked potential (VEP) findings among patients who underwent cosmetic rhinoplasty with those of normal individuals.
Patients and Methods: In this case-control study, 26 eyes of 13 patients were evaluated between 2021 and 2023. The control group consisted of 26 eyes from 13 age-, sex-, and visual acuity-matched healthy individuals. VEP was recorded for both the case and control groups. The latency (in milliseconds) and amplitude (in microvolts) of the VEP P100 peak were compared between the patients and controls.
Results: The mean latency of the VEP P100 peak was 99.61 ± 5.24 milliseconds in the patient group, compared to 98.23 ± 3.59 milliseconds in the control group (P = 0.425). Additionally, the mean amplitude of the VEP P100 peak in the patient group was 7 ± 2.05 microvolts, compared to 6.29 ± 1.97 microvolts in the control group (P = 0.893). The differences for both variables were not statistically significant.
Conclusion: Based on the results, the visual pathway does not appear to be effected significantly among patients undergoing cosmetic rhinoplasty.

Purpose: To examine the effectiveness of laser assisted in situ keratomileusis (LASIK) surgery process education and positive guided imagery in reducing anxiety and enhancing emotional self-regulation among female LASIK candidates.
Patients and Methods: The statistical population for this study consisted of female candidates for LASIK surgery at the operating room of Negah Eye Hospital, Tehran, Iran. A total of 30 participants were selected using convenience sampling over the course of one month and randomly assigned to either an experimental or a control group, with 15 participants in each group. Both the experimental and control groups completed the Athens Physical Activity Questionnaire (APAQ) and the Gross and John Emotion Regulation Questionnaires before the intervention. After completing these questionnaires, the experimental group received comprehensive training on the LASIK procedure, including detailed explanations of the surgical steps, followed by positive mental imagery exercises. The control group received only the standard preoperative instructions. Thirty minutes later, the APAQ was administered again to both groups, and the Gross and John Emotion Regulation Questionnaire was re-administered after surgery.
Results: LASIK surgery process education combined with positive guided imagery significantly reduced preoperative anxiety (P = 0.035) and improved postoperative emotional self-regulation (P = 0.026) among female LASIK candidates.
Conclusion: Education on the LASIK procedure and guided mental imagery effectively reduces preoperative anxiety and enhances postoperative emotional self-regulation among female patients undergoing this procedure.

The legal and ethical aspects of modern medicine have significantly impacted the ophthalmic practice in recent decades. This review examines common aspects of malpractice claims related to ophthalmic practice, providing an overview of the legal process. We discuss practical recommendations for enhancing communication, documentation, and informed consent practices, as well as strategies to improve patient safety to avoid legal challenges. Additionally, advanced risk management approaches are examined, including complication management, alternative dispute resolution, liability insurance, and organizational learning environments that shift focus away from individual blame. By utilizing these proactive risk-reduction measures, ophthalmologists can limit the legal risks and reduce the burden of defensive medicine in their daily practice, and remain focused on delivering optimal patient care. This review might serve as a basic resource for ophthalmologists navigating the legal and ethical complexities of contemporary medical practice.

Purpose: To report a case of pan uveitis in a patient initially suspected of having multiple sclerosis and later diagnosed with neuro-Behçet’s syndrome.
Case Report: We present the case of a 35-year-old pregnant Iranian woman with a history of recurrent pan uveitis and sensory symptoms (Quadriparesis) who was initially treated based on a diagnosis of multiple sclerosis (MS). Upon reevaluation of the clinical and paraclinical findings, the condition of the patient was reclassified as neuro-Behçet’s syndrome and treatment with corticosteroids and immunosuppressive agents was initiated.
Conclusion: The visual and neurologic manifestations of neuro-Behçet’s syndrome can closely mimic those of multiple sclerosis, potentially leading to misdiagnosis. Accurate diagnosis in such cases is critical for achieving optimal treatment outcomes.

Blepharoplasty is one of the most commonly performed procedures. It is among the top five most performed cosmetic surgeries. Although serious complications are possible, most physicians consider the procedure to be relatively safe. However, one of the rare complications associated with blepharoplasty is blindness. We report monocular blindness that occurred in one of our 55-year-old patients as a consequence of a retrobulbar hemorrhage during blepharoplasty.