Background: Descemet stripping and automated endothelial keratoplasty (DSAEK) has gained widespread popularity in the treatment of corneal endothelial dysfunction. In the present study, we evaluated the outcome of DSAEK in our center. Methods: This retrospective cross-sectional study was conducted on 60 patients, who had undergone DSAEK at least 12 months before in Khalili Hospital, Shiraz University of Medical Sciences. On follow-up, best spectacle-corrected visual acuity (BSCVA), refractive errors and specular microscopy parameters were assessed. Results: The majority of the studied eyes (49. 2%) had a BSCVA within the range of 20/40 to 20/30. BSCVA was worse than 20/200 in 8 (13. 3%) patients; 6 (75%) patients showed graft failure and 2 (25%) patients had graft rejection. Mean post-operative astigmatism was 0. 29 1. 88 diopters. Themeanrefractive hyperopic shiftwas1. 30 1. 34 diopters. Specular microscopy indicated that 3 (5. 1%) patients had cell density of less than 700 cells/mm2, but in none of the patients cell density was less than 500 cells/mm2. Furthermore, hexagonality of endothelial cells in 50% of the eyes was 54% to 67%. Mean coefficient of variant was 27. 76%. Abnormal variations in specular microscopy findings were mostly confined to endothelial cell density, sparing other parameters. Conclusions: In general, results of this study demonstrated acceptable BSCVA in the average duration of one-year post-DSAEK regarding late complications such as graft failure, graft rejection and epithelial downgrowth.

Purpose: To determine the safety of LASIK according to decreased BSCVA in myopia and myopic astigmatism.Methods: In this pre and post non-randomized clinical trial, 736 eyes from 369 patient who had LASIK surgery for myopia and myopic astigmatism were evaluated. Mean pre and postoperation visual acuity were measured based on Snellen and Log MAR systems. Results: This study included 62.6% female and 37.4% male patients with a mean age of 30±8 years. Follow up period was 9 months. Preoperative spherical equivalent was -5.2±2.6 diopters. Nine months after surgery this value decreased to -0.28±0.62 diopters. Nine months after operation, 83.7% of the eyes were within ±0.50 diopter of emmetropia. Uncorrected visual acuity was 20/20 or more in 55.8% and 20/40 or more in 97.8% of the eyes. Mean BSCVA before operation was 0.052±0.095and 9 months after operation increased to 0.034±0.069 (P<0.001). Nine months after operation, BSCVA decreased 2 lines in two eyes, 3 lines in one eye, and 4 lines in another eye. Overall the incidence of decreased BSCVA was 0.5%. Conclusion: Regarding decreased BSCVA, LASIK is a safe procedure for myopia and myopic astigmatism.

Purpose: To report the outcomes of manual lamellar keratoplasty (LKP) in patients with delayed-onset mustard gas keratitis (MGK) and compare visual outcomes between subgroups with simultaneous or sequential KLAL and LKP.Methods: In this retrospective, interventional study, 52 eyes of 37 male survivors of chemical warfare with MGK who underwent LKP were included. The results were evaluated with respect to best spectaclecorrected visual acuity (BSCVA), refractive error, keratometric readings and graft clarity. Eyes with sequential versus simultaneous surgery were compared in terms of BSCVA, refraction, corneal graft surface stability, and stem cell and corneal graft survival rates.Results: Mean patient age at the time of surgery was 43.4±8.2 (36-48) years, and mean follow-up period was 41.4±19.6 (19-107) months. Mean preoperative BSCVA was 0.51±0.48 logMAR, which increased to 0.33±0.18 logMAR (P=0.03). Mean preoperative spherical equivalent refractive error was -2.40±1.5 diopters (D), which remained unchanged postoperatively (-1.52±3.7 D, P=0.77). No significant difference between sequential and simultaneous surgery subgroups was observed in BSCVA, refraction, keratometry readings, or corneal graft survival (90.3% and 89.9%, respectively; P=0.68). However, the simultaneous group had statistically better stem cell survival.Conclusion: LKP can effectively improve BSCVA in MGK. The simultaneous approach is superior to sequential surgery when both stem cell and corneal transplantation are indicated.

Purpose: To evaluate the visual outcomes of cross-cylinder ablation in Laser in Situ Keratomileusis (LASIK) for eyes with high astigmatic refractive errors and low spherical component. Methods: We prospectively evaluated cross cylinder LASIK in patients with high astigmatic refractive error but low spherical component over a period of 2 years. All procedures were performed with the Nidek EC- 5000 excimer laser. Main outcome measures included uncorrected visual acuity (UCVA), best spectade corrected visual acuity (BSCVA), manifest refraction, and complications.Results: Thirty-four eyes of 22 patients were included. Patients were followed for 21.8±3.6 months. At the last examination, UCVA of 20/ 40 or better was observed in 33 eyes (97.1%). BSCVA after LASIK improved significantly in comparison to BSCVA before surgery (p<0.005).The mean preoperative cylinder was -4.73±0.89D (-4.00 to -7.00 D) which was reduced to -.29±0.47 D (0.00 to -1.50 D) at the last follow up visit (P<0.001). No cases of postoperative astigmatic regression or corneal haze were observed. Conclusion: Cross cylinder LASIK with the Nidek EC-5000 is a successful procedure for correction of high astigmatism. It seems to be clinically safe, effective and predictable.

Purpose: To compare the visual outcomes of deep anterior lamellar keratoplasty (DALK) for keratoconus with and without successful big‑bubble formation.Methods: In this retrospective comparative study, a total of 289 consecutive eyes from 257 patients underwent DALK using the big‑bubble technique. In cases where the big bubble could not be accomplished, manual stromal dissection down to Descemeton membrane (DM) was performed using a crescent knife. Visual acuity and refractive outcomes were compared between the bare DM group (Group 1) and manual dissection group (Group 2).Results: A bare DM was successfully achieved in 229 (79.2%) eyes and manual dissection was performed in 60 (20.8%) eyes. The study groups were comparable in terms of age (P=0.79), preoperative best‑spectacle corrected visual acuity (BSCVA) (P=0.15), and follow‑up duration (P=0.73). Postoperative BSCVA was significantly better in Group 1 than in Group 2 throughout follow‑up (P<0.05). In Group 2, BSCVA was significantly lower in eyes with advanced keratoconus as compared to those with moderate keratoconus (P= 0.007). At final follow‑up, BSCVA £ 0.30 logarithm of minimum angle of resolution (logMAR) was achieved in 82.1% of eyes in Group 1 versus 54.5% of eyes in Group 2 (P<0.001). Groups 1 and 2 were comparable in terms of postoperative spherical equivalent refractive error (P=0.61) and keratometric astigmatism (P=0.39).Conclusion: Retention of the posterior corneal stroma which occurs with manual dissection during failed big bubble formation in DALK is associated with lower visual acuity as compared to achieving a bare DM.

Purpose: To evaluate the effects of donor graft thickness on postoperative best spectacle‑ corrected visual acuity (BSCVA), refractive outcomes, endothelial cell density (ECD) and function, intraocular pressure (IOP), and postoperative complications after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: This retrospective, interventional case series enrolled 77 eyes of 64 patients who underwent DSAEK with or without simultaneous cataract surgery. Clinical outcomes, including BSCVA, refraction, keratometric astigmatism, IOP, and ECD were assessed at the final follow‑ up examination. Univariate analyses were used to investigate the effects of postoperative donor graft thickness on clinical outcomes and complications. Results: The mean patient age was 62. 3 ± 15. 6 years, and the patients were followed for 26. 2 ± 20. 9 months postoperatively. The mean postoperative central graft thickness was 102. 4 ± 31. 6 µ m. In the univariate analysis, postoperative central graft thickness was significantly associated with postoperative IOP (P = 0. 005), central recipient thickness (P = 0. 002), and ECD (P = 0. 016). No significant association was found for central graft thickness with postoperative BSCVA (P = 0. 70), spherical equivalent refraction (P = 0. 33), keratometric astigmatism (P = 0. 27), graft detachment (P = 0. 16), graft decentration (P = 0. 17), high IOP (P = 0. 53), or endothelial rejection (P = 0. 88). Conclusion: This study failed to demonstrate any significant correlation between graft thickness and BSCVA. Attempting to minimize graft thickness might not have the desired outcome regarding endothelial cell density and function. Increased graft thickness could negatively impact the accuracy of IOP measurements after DSAEK.

Purpose: To evaluate the outcome of iris-claw phakic intraocular lens (PIOL) implantation for high myopia in a subspecialty training setting. Methods: Iris-claw phakic Artisan (Ophtec B.V., Groningen, The Netherlands) intraocular lens implanted patients were invited for an evaluation visit: 83 eyes had been operated on by a group of 10 cornea fellows under the supervision of nine anterior segment faculty members during 2005-2006. Postoperative time course ranged from four to 38 months. The outcome was assessed in those who participated in the evaluation visit (50 eyes collectively). Results: Evaluation visit uncorrected visual acuity (UCVA) was equal to or better than preoperative best spectacle corrected visual acuity (BSCVA) in 68% of the eyes; mean BSCVA had improved significantly (equivalent to two Snellen lines; P<0.004). Residual spherical equivalent (SE) was within ±1.00 diopter (D) in 68% and ±2.00 D in 92%; eyes with longer postoperative time courses (>10 months) were on average 0.94 D more myopic (P=0.007). No eye had lost BSCVA. No major complication like retinal detachment or cataract had happened. Better UCVA was predictable by shorter postoperative time course, milder baseline myopia, and better baseline BSCVA (P<0.004).Conclusion: Iris-claw PIOL implantation for high myopia was found efficacious and safe in subspecialty training. A noticeable myopic drift was observed, and refractive predictability was not as favorable as expected. Induced astigmatism, miscalculation, mislabeling/wrong refraction, and myopic progression could have been responsible for >2.00 D residual SE in four eyes.

Purpose: To evaluate visual acuity and refractive error after deep anterior lamellar keratoplasty (DALK) using Anwar's technique in patients with post-LASIK ectasia. Methods: Pre- and postoperative data of patients who had developed ectasia after LASIK and hence underwent DALK by Anwar's technique were compared. Main outcomes measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent refractive error, mean keratometry and keratometric stigmatism. Results: Eleven eyes of 10 patients were included. Mean age was 31.6±7.4 years and mean follow-up period was 20.2±6.5 months. Intraoperatively, a bare Descemet's membrane was successfully achieved in all cases. Mean UCVA and BSCVA were increased from 20/400 to 20/160 (P=0.39) and from 20/160 to 20/40 (P=0.007), respectively. Mean spherical equivalent refractive error was increased from -11.53±5.4 D to -13.47±0.5 D (P=0.34). Mean keratometry and keratometric astigmatism remained unchanged. Conclusion: DALK using Anwar's technique is a safe and reproducible procedure for post-LASIK ectasia. However, a high refractive error should be expected postoperatively.

Background and Objective: Evaluation of the results, safety, and stability of ferrara intracorneal ring segment (FICRS) implantation for Keratoconus correction (age range was 24.39±8.32 years).Materials and Methods: In this clinical trial study, 64 eyes of 57 patients with keratoconus and clear cornea that had FICRS implantation were studied. Uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), refractive errors, and corneal data from Orb scan II, and complications were analyzed.Results: The follow-up was 18 months ± 6.45 (SD), the UCVA improved from 1.14 logarithm of the minimum angle of resolution (Log MAR) ± 0.53 (SD) to 0.48 og MAR ± 0.44 (SD) (P£ 0.001) and the BSCVA improved from 0.44 Log MAR ± 0.40 (SD) to 0.23 Log MAR ± 0.19 (SD) (P£ 0.001). Improvement of main outcome measures were as follows: 4.90 diopter (D) ± 3.33 (SD) for Spherical equivalent (P£ 0.001), 4.16 D ±3.24 (SD) for Spherical refractive error (P£ 0.001), 1.49±2.31 (SD) for cylindrical refractive error (P£ 0.001). Corneal topography showed more improvement of corneal uniformity and irregular astigmatism. Minimum and maximum central corneal powers decreased 1.75 D±5.94 (SD) (P£ 0.03) and 4.75 D±3.33 (SD) (P£ 0.001), respectively. Significant decrease in anterior corneal curvature and posterior best-fit sphere curvature were observed. Segment extrusion one eye (16%), superficial position 1 eye (1.6%), and infectin in 5 eyes (7.8%) had occurred. Conclusion: During 18 months, FICRS implantation improved both UCVA and BSCVA, however, it reduced corneal steepening and astigmatism. Whereas, increased topographic regularity. FICRS implantation was a safe procedure that had led to stable results. This procedure prevented or delayed corneal graft in many cases.

Purpose: To report the outcomes of penetrating keratoplasty (PKP) in patients with macular corneal dystrophy (MCD).Methods: This retrospective case series includes consecutive patients with MCD who underwent PKP from 1986 to 2006 with at least 6 months’ follow-up. Main outcome measures included best spectacle-corrected visual acuity (BSCVA), postoperative astigmatism and graft survival.Results: Sixty-two eyes of 39 patients with mean age of 34.0±10.5 (range 13-58) years at the time of keratoplasty were included for analysis. After a mean follow-up period of 52.0±47.3 (range 6-190) months, BSCVA improved from 1.4±0.4 logMAR (4/100) preoperatively to 0.2±0.3 logMAR (20/32) at final follow-up (P<0.001). Mean postoperative BSCVA was 0.15±0.40 logMAR in patients (36 eyes) aged less than 35 years at the time of surgery as compared to 0.26±0.25 logMAR in subjects (26 eyes) older than 35 years (P=0.005). Final astigmatism was comparable with different suturing techniques including separate, continuous, and combined sutures (P=0.9). All grafts were clear at final follow-up except a single case of MCD with visually insignificant recurrence. Episodes of immunologic graft rejection occurred in 12 eyes (19.4%) but none led to graft failure.Conclusion: PKP for MCD entails favorable outcomes in terms of graft survival and visual improvement. Final visual acuity seems to be better when transplantation is performed before the age of 35 years.