BINA
Year:2014 | Volume:19 | Issue:3 (76)|Papers Count:12

Purpose: To customize clinical practice guidelines (CPGs) for cataract management for Iranian population.Methods: First, four CPGs (American Academy 2006 and 2011, Royal College of Ophthalmologists 2010 and Canadian Ophthalmological Society evidence-based clinical practice guidelines 2008) were selected from a number of available CPGs for cataract management in the literature. Second, all recommendations of these guidelines together with their supporting sources were studied. Each recommendation was summarized in 4 tables; the first table entailed the recommendation itself in clinical question components format along with its level of evidence. The second table contained the abstracts of the supporting articles in clinical question components format together with their levels of evidence. The third table covered the customized recommendation of the group respecting Iran’s condition, its clinical advantage, cost and complications. In the fourth table, the customizing team scored the recommendation from 1 to 9 based on the customizing capability of the recommendation (applicability, acceptability, external validity). At last, customized recommendations were sent to the faculty members of all universities across the country one month prior to the consensus session asking their comments.Results: The agreed-upon items were accepted as the conclusive recommendations while the ones that they had no agreements on were discussed at the consensus session. Finally, all customized recommendations were codified as 81 recommendations along with their sources and levels of evidence for Iranian population.Conclusion: It seems that customizing the CPGs of adult cataract management could be effectively useful in standardization of referral, diagnosis and treatment of the affected subjects.

Methods: This is a cross-sectional population-based survey performed between 2010 and 2011. The participants were among the subjects aged from 40 to 80 years old. The samples were selected from urban and rural inhabitants using multi-stage random cluster sampling design. All participants underwent manifest refraction, visual acuity measurements, retinoscopy and funduscopy. Myopia, hyperopia, astigmatism and anisometropia were defined as, spherical equivalent (SE)>-0.50 D, >+0.50 D, cylinder power>0.5 D, as well as a difference of 1 D or higher in SE of the right and left eyes, respectively.Results: Of 2320 individuals selected, 2098 (90.4%) subjects participated in the study. out of which, 198 subjects were excluded due to previous surgical history. Prevalence of myopia, hyperopia, astigmatism, and anisometropia were 36.5% (95% confidence interval [95% CI]; 33.6-39.4%), 20.6% (95% CI; 17.9-23.3%), 53.8% (95% CI; 51.3-56.3%), 11.9% (95% CI; 10.4-13.4%), respectively. Myopia³-6 D and hyperopia³+4 D were observed in 2.3% (95% CI; 1.6-2.9%) and 1.2% (95% CI; 0.6-1.8%) of participants, respectively. Multiple logistic regression model shows that myopia prevalence significantly increased in female subjects. In addition, the prevalence of hyperopia, astigmatism, and anisometropia directly correlated with age. With-therule, against-the-rule and oblique astigmatisms prevalence were 35.7%, 13.4% and 4.6%, respectively; prevalence of against-the-rule astigmatism increased from 27.6% among 40-49 year-old subjects to 55.2% among 70-80 year-old subjects (OR=1.044, 95%CI, 1.034-1.054, P<0.001). With-the-rule astigmatism prevalence was significantly higher in women (P=0.038).Conclusion: More than half of the study population had at least one refractive error; myopia and astigmatism prevalence were found to be considerably higher compared to previous studies in Iran. As the refractive errors are a main cause of avoidable visual impairment, high prevalence of refractive errors in this study is important from a public health perspective.

Purpose: To evaluate the correlation between refractive, corneal and lenticular astigmatism and higher order aberrations (HOA) in refractive surgery candidates Methods: This cross-sectional descriptive-analytical study consisted of 400 eyes (200 patients) who were referred between 2011 to 2013 to Farabi Eye Hospital for refractive surgery. Refraction, topography and aberrometry were performed to determine refractive, corneal and lenticular astigmatism and HOA for all of participants and statistical analyses were performed using software SPSS version 20.Results: Overall, 400 eyes of 200 subjects with the mean age of 28.2±6.24 years (range 20-52 years) participated in this study; among whom (250 eyes) 62.7% of cases were female; According to spherical equivalent, 375 eyes (94.2%) were myope and 13 eyes (3.3%) were hyperope and 315 eyes (78.9%) had refractive astigmatism greater than 0.75 D. Mean spherical equivalent refractive errors in the myopic group was -3.59±1.95 D (range, -0.54 to -10.22 D) and in the hyperopic group was 2.72±0.97 D (range, 0.67 to 4.23 D) with a mean astigmatism of -1.97±1.3 D and -1.3±1.37 D in each group, respectively.The root mean square (RMS) of higher order aberrations was 0.38±0.15 mm in all cases. It was 0.38±0.15 mm in myopic group and 0.39±0.15 mm in hyperopic group which positively correlated with SE in both groups (P<0.001). There was a significant statistical correlation between corneal astigmatism and HOA (P=0.03) and between lenticular astigmatism and HOA (P=0.02). The correlation between refractive astigmatism and HOA was borderline (P=0.08).Conclusion: There are significant correlations between refractive, corneal and lenticular astigmatisms and higher order aberrations. Therefore, to achieve better vision and prevention of halos and glare and night vision problems after surgery, we recommend evaluating all aberrations in refractive surgery candidates especially in patients who have high astigmatism to consider them for customized ablations.

Purpose: To evaluate the effect of human amniotic fluid (HAF) on the growth of human corneal endothelial cells (HCECs) and to establish an in vitro method for the expansion of HCECs.Methods: HCECs were cultured in DMEM-F12 supplemented with 20% fetal bovine serum (FBS). Confluent monolayer cultures were trypsinized and passaged using 20% FBS- or 10%, 20%, or 30% HAF-containing media. Cell proliferation and cell death ELISA assays were performed to assess the effect of HAF on cell growth and viability. The identity of cells cultured with 20% HAF were studied using immunocytochemistry (ICC) and Real-Time RT-PCR techniques for markers presenting specific characteristics of HCECs including Ki-67, Vimentin, Na/K-ATPase and ZO-1.Results: Primary cultures of HCECs were successfully established under HAF-containing media which led to rapid cell proliferation according to cell proliferation and death ELISA assays. Real-Time PCR and ICC revealed that expression of Na/K-ATPase and ZO-1 in 20% HAF cell cultures was more compared to controls (20% FBS).Conclusion: HAF containing medium exhibited an invaluable stimulatory effect on HCEC growth. It can be regarded as an enriched supplement in HCECs regeneration studies.

Purpose: To compare the accommodative response values of two dynamic retinoscopy methods; monocular estimate method (MEM) and Nott dynamic retinoscopy.Methods: In this study 48 patients (29 men) with normal visual system underwent MEM and Nott retinoscopy.The agreement between the two methods was tested using Bland-Altman method. The correlation between data was tested using Spearman non-parametric method.Results: Mean age of the patients was 23.2±9.3 (range, 18-36) years. Mean accommodative response values of MEM and Nott dynamic retinoscopy were +1.01±0.67 and +0.84±0.53 D, respectively with mean difference of 0.18±0.38 and 95% limits of agreement of ±0.74. Based on Spearman's non-parametric method, there was a significant correlation between differences and mean value accommodative response of the two methods (R=0.41, P=0.004).Conclusion: Despite the difference between the two methods was small, this difference depends on the degree of the response to some extent and this difference may increase in higher values of accommodative response.

Purpose: To assess the optical effect of the technis-z9000 IOL decentration by Lio-Brennan mathematicoptical eye model.Methods: The phantom with real eye parameters (Lio-Brennas) was used for IOL Technis-z9000 modeling with Zemax code. Modulation Transfer Function (MTF) and MTF Contrast that represent the ratio of the image data to total object data in optical system were used for analysis.Results: A 0 to 0.2-mm decentration of IOL on+X direction showed good contrast and MTF but, MTF and Contracst reduced continuously with decentration³0.4 mm. Increasing the IOL decentration on -X resulted in a reduction of MTF and Contrast, so that decentration³-0.4 mm led to a significant reduction in MTF and Contrast. IOL decentration on±Y demonstrated a symmetrical reduction in MTF and Contrast in two directions.Conclusion: Decentration of the Technis-z9000 IOL led to degradation of the visual quality in both X and Y directions. This effect was remarkable when decentration was more than 0.4 mm.

Purpose: To determine the effect of retained donor Descemet membranes (DMs) on visual outcomes following deep anterior lamellar keratoplasty (DALK).Methods: In this retrospective comparative study, keratoconic eyes undergoing DALK using the big-bubble technique were enrolled. A bared DM was achieved in all cases. A donor cornea without (group 1; 48 eyes) or with (group 2; 22 eyes) DM was sutured to the recipient bed. The 2 groups were compared in terms of best spectacle-corrected visual acuity, keratometric astigmatism, refractive error, contrast sensitivity (CS), higherorder aberrations (HOAs), and central graft thickness at least 3 months after complete suture removal.Results: The mean follow-up duration was 23.2±6.9 months in group 1 and 26.5±6.5 months in group 2 (P=0.61). The postoperative best spectacle-corrected visual acuity was 0.18±0.08 logMAR and 0.24±0.30 logMAR, respectively (P=0.36). The 2 groups had comparable postoperative keratometric astigmatism, spherical equivalent refraction, and HOAs. In terms of CS, however, group 1 demonstrated better results at a low spatial frequency. The mean postoperative central graft thickness was greater in group 2 (589.8±34.5 mm) than in group 1 (523.6±63.0 mm; P<0.001).Conclusion: DALK using the big-bubble technique for keratoconus may give better results in terms of CS if a donor cornea without DM is transplanted.

Purpose: To evaluate the effect of early aqueous suppressants initiation on Ahmed glaucoma valve success rate.Methods: In this randomized clinical trial, a total of 94 eyes of 94 patients with refractory glaucoma were enrolled. The eyes were randomly selected into 2 groups. In group 1 (n=47), patients received early topical combination of Timolol-Dorzolamide twice daily after Ahmed glaucoma valve implantation when the intraocular pressure (IOP) reached 10 mmHg. After 3 months the glaucoma medications were adjusted (decreased or increased) based on target pressure. In control group (n=47), patients received stepwise glaucoma medications when IOP reached higher than target. Main outcome measures included cumulative probabilities of success rate (defined as IOP between 6 and 15 mmHg, and 30% reduction in IOP), IOP, the number of medications, and the rate of hypertensive phase.Results: Cumulative probabilities of success rate was significantly higher in group 1 compared with control at months 6 (70.5% versus 32.6%, P<0.001) and 12 (63.2% versus 33.2%, P=0.008). Mean IOP was statistically lower in group 1 between weeks 1 and 54 (P<0.05). Number of medications in group 1 was statistically higher between weeks 1 and 12 (P<0.001) but was not different at weeks 24 and 54 (P=0.180 and P=0.197 respectively).The rate of hypertensive phase was significantly less in group 1 compared with control (23.4% versus 66%, P<0.001).Conclusion: Early initiation of aqueous suppressants after Ahmed glaucoma valve implantation can improve success rate.

Purpose: To compare the success rate of external dacryocystorhinostomy (DCR) with and without bicanalicular silicone intubation for the management of primary acquired nasolacrimal duct obstruction.Methods: In this study, 51 eyes from 50 patients who were diagnosed with primary acquired nasolacrimal duct obstruction underwent external DCR. Patients with history of trauma and/ or surgery in the periorbital area, and punctal or canalicular obstruction were excluded from the study. In 25 eyes, bicanalicular silicone intubation was performed intraoperatively (group 1), while 26 eyes underwent DCR without intubation (group 2). The evaluated variables were age, gender, history, and presenting symptoms. All procedures were performed by one oculoplastic surgeon. Tube removal was planned for 6 weeks postoperatively and 3 months after tube removal treatment success was assessed. Treatment was considered successful if Munk score was 0-1 three months after tube removal.Results: The mean age±standard deviation was 48.3±21.2 and 46±15.7 years in groups 1 and 2, respectively (P=0.66). The male/female ratio was 9.17 and 5.20, respectively (P=0.242). The mean age of male and female participants in each study group was 38.3±16.2, 53.5±22 and 37.6±18.2, 48.1±14.8 years, respectively. The mean follow up was 6.1±1.6 weeks in group 1 and 7.2±2.5 weeks in group 2.Conclusion: Both techniques have high success rate. We believe that the success rate depends mainly on the surgeon’s experience.