AIM:To compare the tear film quantity and stability parameters in keratoconus(KCN)and normal eyes using test breakup time(TBUT),noninvasive TBUT(NITBUT),and Schirmer test.METHODS:All participants(n=166),including pati...AIM:To compare the tear film quantity and stability parameters in keratoconus(KCN)and normal eyes using test breakup time(TBUT),noninvasive TBUT(NITBUT),and Schirmer test.METHODS:All participants(n=166),including patients with KCN and age-matched healthy individuals with normal corneas,were recruited from those referred to Farabi Eye Hospital,Iran,in 2023.To better account for genetic and environmental factors,the control group comprised healthy individuals who were relatives of KCN patients and had normal corneal topography.Tear quantity parameters were evaluated in the following order:NITBUT,TBUT,and Schirmer tests.RESULTS:The mean age of cases in KCN(61.7%males)and normal(63.5%males)participants was 27.54±5.44y(range 19 to 38)and 27.52±5.63y(range 20 to 38),respectively(P=0.976).NIBUT,TBUT,and Schirmer’s tests were significantly lower in KCN group compared to normal controls(all P<0.001).The mean difference for NIBUT was-7.81s(P<0.001),and for TBUT was-7.61s(P<0.001).Schirmer test values were also significantly lower in the KCN group,with a mean difference of-5.61 mm compared to normal people(P<0.001).CONCLUSION:Our findings demonstrate significant tear film impairment in KCN.The reductions in NIBUT,TBUT and Schirmer scores highlight an underlying tear film dysfunction in KCN that extends beyond the morphological changes of the cornea.展开更多
AIM:To compare refractive error and angle of deviation in patients with basic esotropia and basic exotropia.METHODS:A retrospective review was conducted on the medical records of patients with basic-type strabismus.De...AIM:To compare refractive error and angle of deviation in patients with basic esotropia and basic exotropia.METHODS:A retrospective review was conducted on the medical records of patients with basic-type strabismus.Demographic data,refractive error,best-corrected distance visual acuity(BCVA),and the horizontal and vertical angle of deviation between basic esotropia and exotropia patients were compared.RESULTS:Among the 7129 patients(mean age 22.98±14.81y)evaluated,44.7%(3185 cases,54.9%male)exhibited basic-type esotropia,while 55.3%(3944 cases,53.9%male)presented with basic-type exotropia.Basic esotropia cases exhibited more hyperopic spherical equivalent measurements in both eyes(right:0.53±3.07 vs left:0.56±2.98 D)than those with basic exotropia(right eye:-0.33±2.84 vs left eye:-0.24±2.68 D,P<0.001 for both eyes).Patients with basic esotropia had significantly greater horizontal deviation angles(near:36.08±18.87 PD and far:35.56±18.75 PD)compared to those with basic exotropia(near:33.75±16.11 PD and far:33.26±15.90 PD,P<0.001).Conversely,patients with basic exotropia had slightly higher vertical deviation angles(near:1.67±5.80 PD and far:1.72±5.89 PD)compared to those with basic esotropia(near:1.12±4.57 PD and far:1.12±4.58 PD,P<0.001).Patients with basic esotropia underwent surgical intervention at younger ages compared to basic exotropia individuals(19.68±15.99 vs 25.66±13.20,P<0.001).CONCLUSION:Basic esotropia patients present more hyperopic refractive errors,better visual acuity,larger horizontal yet smaller vertical ocular misalignments,and tend to undergo strabismus surgery at younger ages relative to basic exotropia cases.展开更多
AIM:To explore the prevalence of pterygium and pinguecula and their risk factors.METHODS:This population-based cross-sectional study was conducted on geriatric population aged 60 and over in Tehran,Iran from Jan 2019 ...AIM:To explore the prevalence of pterygium and pinguecula and their risk factors.METHODS:This population-based cross-sectional study was conducted on geriatric population aged 60 and over in Tehran,Iran from Jan 2019 to Jan 2020.Selected subjects were interviewed and subjected to optometric and ophthalmic examinations.RESULTS:The age and sex standardized prevalence of pterygium and pinguecula was 3.64%[95%confidence interval(CI):2.94%–4.49%]and 55.57%(95%CI:52.89%–58.22%),respectively.The prevalence of pterygium was 4.52%(95%CI:3.5%–5.81%)in men and 2.79%(95%CI:1.97%–3.94%)in women and the prevalence of pinguecula was 64.56%(95%CI:60.92%–68.03%)in men and 46.72%(95%CI:43.74%–49.72%)in women.According to the results of multiple logistic regression,pinguecula had a significant correlation with male sex[odds ratio(OR):2.21,95%CI:1.63–2.99]and education level(OR:0.52,95%CI:0.35-0.77)and pterygium had a significant relationship with male sex(OR:2.2,95%CI:1.38–3.52),socioeconomic status(SES,OR:0.5,95%CI:0.26–0.97),education level(OR:0.22,95%CI:0.08–0.61).CONCLUSION:The prevalence of pinguecula and pterygium in this study are lower than other studies.Sex,SES,and education level are the risk factors of the prevalence of pinguecula and pterygium.展开更多
AIM:To compare objective dry retinoscopy and subjective refraction measurements in patients with mild keratoconus(KCN)and quantify any differences.METHODS:This cross-sectional study was done on 68 eyes of 68 patients ...AIM:To compare objective dry retinoscopy and subjective refraction measurements in patients with mild keratoconus(KCN)and quantify any differences.METHODS:This cross-sectional study was done on 68 eyes of 68 patients diagnosed with mild KCN.Objective dry retinoscopy using autorefractometer and subjective refraction measurements were performed.Sphere,cylinder,J0,J45,and spherical equivalent values were compared between the two techniques.RESULTS:The mean age of 68 patients with mild KCN was 21.32±5.03y(12–35y).There were 37(54.4%)males.Objective refraction yielded significantly more myopic sphere(-1.44 D vs-0.57 D),higher cylinder magnitude(-2.24 D vs-1.48 D),and more myopic spherical equivalent(-2.56 D vs-1.31 D)compared to subjective refraction(all P<0.05).The mean differences were-0.87 D for sphere,-0.76 D for cylinder,and-1.25 D for spherical equivalent.No significant differences were found for J0 and J45 values,indicating agreement in astigmatism axis(P>0.05).CONCLUSION:In patients with mild KCN,objective dry retinoscopy overestimates the degree of myopia and astigmatism compared to subjective refraction.The irregular cornea in KCN likely impacts objective measurements.Subjective refraction allows compensation for irregularity,providing a more accurate correction.When determining refractive targets,the tendency of objective methods to overcorrect should be considered.展开更多
AIM:To identify differences in clinical features between thyroid eye disease(TED)patients with and without strabismus.METHODS:This retrospective,single-center,consecutive case series study was conducted on TED patient...AIM:To identify differences in clinical features between thyroid eye disease(TED)patients with and without strabismus.METHODS:This retrospective,single-center,consecutive case series study was conducted on TED patients who were determined to be surgical candidates.The patients’cohort were divided into two groups based on the presence or absence of strabismus.Demographics and complete eye examinations were recorded and compared between the TED and TED with strabismus groups.RESULTS:A total of 76 patients with TED were enrolled,including 58 males(76.3%)with a mean age of 52.68±10.45y.The 55 patients(male:female=2:1)were found to have TED with strabismus,while the remaining 21 patients(male:female=4:1)had TED without strabismus.There was nearly a four times greater likelihood of lid retraction being associated with TED without strabismus(OR=4.1,P=0.018)and they showed higher prevalence of proptosis(95.2%)than the TED strabismus group(63.6%,P<0.001).In the TED-strabismus group,20%of patients had abnormal head posture(AHP),while none were identified in the TED group(P=0.029).Despite the higher incidence of vision-threatening complications such as dysthyroid optic neuropathy(19%vs 8.1%)and exposure keratopathy(4.8%vs 1.8%)in the TED group than in the TED-strabismus group,the difference did not reach statistical significance(P>0.05).The most common types of strabismus were hypotropia(36%)and esotropia(29%),respectively.CONCLUSION:Strabismus-associated TED is characterized by a lower prevalence of proptosis and lid retraction,but a higher incidence of compensatory AHP.Identifying these differences may aid in risk stratification and early intervention for TED patients,particularly those at risk for restrictive strabismus.展开更多
This narrative review aimed to have an algorithmic approach to microphthalmos by a systematic search.The definition can be related to a number of special phenotypes.In the more challenging cases of complex microphthal...This narrative review aimed to have an algorithmic approach to microphthalmos by a systematic search.The definition can be related to a number of special phenotypes.In the more challenging cases of complex microphthalmos,relative anterior microphthalmos,and nanophthalmos,the surgeon can approach these cases more safely if they have a deep understanding of the anatomical variations and ideal formulae for intraocular lens computation and knows how to avoid intra-and post-operative complications.In this article,we review the criteria by which we recognize and describe pre-,intra-,and post-operative considerations,as well as discuss the ideal intraocular lenses for microphthalmos,given the intricate varieties of small eye phenotypes.展开更多
AIM:To compare outcomes of applying preservative free artificial tears(PFAT)with and without hyaluronic acid(HA)in early postoperative course following photorefractive keratectomy(PRK).METHODS:In this triple-blinded r...AIM:To compare outcomes of applying preservative free artificial tears(PFAT)with and without hyaluronic acid(HA)in early postoperative course following photorefractive keratectomy(PRK).METHODS:In this triple-blinded randomized clinical trial,PRK procedure was performed on both eyes of 230 patients.Following PRK,patients were divided into three groups:the HA^(+)group,44 patients PFAT containing HA;the HA-group,71 patients PFAT without HA were administered 5 times per day(every 4 h);the third group,115 patients received no PFAT before lens removal.On the 1st and 4th postoperative day,Visual Analogue Score(VAS)was utilized to evaluate patient’s level of pain.Participants were asked to complete a questionnaire about the severity of eye discomfort ranked from 0 to 10(0=no complaint;10=most severe complaint experienced).RESULTS:In eyes receiving PFAT with or without HA(Drop group),mean scores for epiphora,foreign body sensation,and blurred vision on the 1st postoperative day were statistically lower(P<0.05).Filamentous keratitis(FK)was detected in 11(4.7%)eyes,and recurrent corneal erosion(RCE)was observed in 5(2.1%)eyes.In the control group,FK was noted in 16(6.9%)eyes while 13(5.6%)eyes had RCE and 5(2.1%)eyes had corneal haze.The rate of complications was statistically lower in Drop group(P=0.009).However,the aforementioned scores were not statically different between HA^(+)and HA-group one and two(P=0.29).CONCLUSION:Following PRK,applying PFAT with and without HA yields faster visual recovery,decreases postoperative ocular discomfor t and haze formation;however there is no additive effect for HA.展开更多
AIM:To evaluate the effect of axial length(AL)and anterior chamber depth(ACD)on peripheral refractive profile in myopic patients compared to emmetropic participants.METHODS:This cross-sectional study was conducted in ...AIM:To evaluate the effect of axial length(AL)and anterior chamber depth(ACD)on peripheral refractive profile in myopic patients compared to emmetropic participants.METHODS:This cross-sectional study was conducted in right eyes of 58 participants of whom 38 were emmetropic and 20 were myopic.Central and peripheral refraction were measured at 10°,20°,and 30°eccentricities in nasal and temporal fields using an open-field autorefractor.The Lenstar LS900 was used to measure ACD and AL.The participants were divided into three groups of short(<22.5 mm),normal(22.5-24.5 mm),and long eye(>24.5 mm)according to AL and three groups of low ACD(<3.00 mm),normal ACD(3.00-3.60 mm),and high ACD(>3.60 mm)according to ACD.RESULTS:The mean age of the participants was 22.26±3.09 y(range 18-30 y).The peripheral mean spherical refractive error showed a hypermetropic shift in myopic and emmetropic groups although this shift was more pronounced in the myopic group.The results showed significant changes in the spherical equivalent,J0,and J45 astigmatism in all gazes with an increase in eccentricity(P<0.001).The pattern of refractive error changes was more noticeable in long and short eyes versus normal AL eyes.Moreover,the pattern of peripheral refractive changes was much more prominent in the high ACD group versus the normal ACD group and in the normal ACD group versus the low ACD group.CONCLUSION:Peripheral refraction changes are greater in participants with AL values outside the normal range and deeper ACD values compared to participants with normal AL and ACD.展开更多
AIM:To conduct a cost-utility analysis of the teleretinopathy of prematurity(ROP)screening program against no screening.METHODS:A decision tree model was developed to identify and treat the infants with threshold ROP ...AIM:To conduct a cost-utility analysis of the teleretinopathy of prematurity(ROP)screening program against no screening.METHODS:A decision tree model was developed to identify and treat the infants with threshold ROP through the tele-screening system compared with no screening program from the societal perspective.We used the quality adjusted life years(QALY)index to measure the scenarios’effectiveness,which was discounted for the future years by 0.058.One hundred twenty-six randomly selected newborns with ROP required treatment were investigated to extract the treatment information.We considered the direct medical and non-medical costs in cost calculations analysed by the bottom-up approach.The figures of the model’s inputs were calculated using the Monte Carlo simulation that generated 1000 random iteration of the data,and a one-way sensitivity analysis was performed on the model to cope with the potential uncertainties.RESULTS:The total and per capita needed the budget to establish a tele-ROP screening system were estimated at over 1.5 million and 35.13 USD,respectively.The total cost of identifying and treating an ROP case in tele-screening and no screening strategies were obtained as 108.72 and 63.52 USD,respectively,and their lifetime discounted QALY gained were calculated as 15.39 and 15.11,respectively.Therefore,incremental cost-effectiveness ratio(ICER)of tele-screening strategy against the competitive strategy was achieved as 161.43 USD.CONCLUSION:Tele-ROP screening program is one of the most cost-effective interventions in the Iranian health system and has a high priority to receive a budget for implementation.展开更多
Dear Editor,We have presented the clinical findings of a case with bilateral early-onset central toxic keratopathy(CTK) followed by bilateral late-onset post-LASIK keratectasia. Laser in situ keratomileusis(LASIK) is ...Dear Editor,We have presented the clinical findings of a case with bilateral early-onset central toxic keratopathy(CTK) followed by bilateral late-onset post-LASIK keratectasia. Laser in situ keratomileusis(LASIK) is a safe procedure to treat a broad spectrum of refractive errors;however, unexpected and rarely encountered post-LASIK complications could be a challenge for patient and surgeon.展开更多
AIM:To determine the distribution and associated factors of intraocular pressure(IOP) in an Iranian elderly population 60 years of age and above.METHODS:The present report is part of the Tehran Geriatric Eye study(TGE...AIM:To determine the distribution and associated factors of intraocular pressure(IOP) in an Iranian elderly population 60 years of age and above.METHODS:The present report is part of the Tehran Geriatric Eye study(TGES),a population-based cross-sectional study that was conducted on the residents of Tehran 60 years of age and above.The sampling was performed using multistage stratified random cluster sampling methods from 22 districts of Tehran,Iran.Demographic and history information,blood samples,and blood pressure were collected from all participants.Ocular examinations included measurement of uncorrected and best-corrected visual acuity,objective and subjective refraction,and slit-lamp biomicroscopy.The IOP was measured using Goldmann applanation tonometry(GAT).Corneal imaging and ocular biometry were performed using Pentacam AXL.RESULTS:The data of 3892 eyes of 2124 individuals were analyzed for this report.The mean age of the study participants was 66.49±5.31y(range:60 to 95y).The mean IOP was 15.2 mm Hg(95%CI:15.1 to 15.4),15.3 mm Hg(95%CI:15.1 to 15.5) and 15.1 mm Hg(95%CI:15.0 to 15.3) in all participants,males,and females,respectively.Of the study participants,1.3% had an IOP of ≥20 mm Hg.The mean IOP increased from 15.1 mm Hg in the age group 60-64y to 16.3 mm Hg in the age group ≥80y.According to the final multiple GEE model,the IOP was statistically significantly higher in men than in women.All the studied age groups,except for the 75-79-year-old age group,had significantly higher IOP compared to the 60-64-year-old age group.The IOP was significantly higher in underweight compared to other body mass index groups.Moreover,the IOP had a statistically significant direct relationship with the mean corneal power(mean CP),central corneal thickness(CCT),and systolic blood pressure.CONCLUSION:The present study presents the distribution of IOP in an Iranian elderly population.A higher IOP(within the range 14 to 17 mm Hg) is significantly associated with older age,male sex,high systolic blood pressure,increased mean CP,and CCT.These factors should be considered in the clinical interpretation of IOP.展开更多
AIM:To determine the prevalence of some retinal pathologies in people over 60y and their association with demographic and ocular factors.METHODS:A cross-sectional study was conducted in Tehran using multistage cluster...AIM:To determine the prevalence of some retinal pathologies in people over 60y and their association with demographic and ocular factors.METHODS:A cross-sectional study was conducted in Tehran using multistage cluster sampling.After selecting subjects aged 60 and over,optometric,and ophthalmic examinations were done.For retinal examination,a 90 D lens was used and indirect ophthalmoscopy was performed after instilling tropicamide drops.Biometry was done using the IOL Master for all participants.RESULTS:Of 3791 people that were invited through cluster sampling,3310 participated in the study(response rate=82%).The prevalence of retinal pigmented epithelium(RPE)change,drusen,geographic atrophy(GA),hypertensive retinopathy(HTR),nonproliferative diabetic retinopathy(NPDR),proliferative diabetic retinopathy(PDR),choroidal neovascularization(CNV),central retinal artery occlusion(CRAO),myopic retinopathy(MR),branch retinal vein occlusion(BRVO),and central retinal vein occlusion(CRVO)was 27.42%,11.08%,4.52%,3.03%,4.05%,0.54%,0.82%,0.39%,0.20%,0.49%,and 0.19%,respectively.After removing the effect of age,the odds of NPDR were 1.68 times higher in women compared to men(P=0.014).After removing the effect of sex,the odds of drusen,RPE change,GA,CNV,BRVO,and CRVO increased with age.CONCLUSION:There is a higher prevalence of RPE change,drusen,GA,CNV and a lower prevalence of MR and CRAO in the elderly population of Tehran aged over 60y compared to global average values.Considering the correlation of most of the diseases with age and their effects on vision,attention should be paid to these diseases and the related screening programs to prevent vision impairment.展开更多
Background:To assess the diagnostic ability of Pentacam HR(Oculus Optikgeräte,GmbH,Wetzlar,Germany)tomographic indices in discriminating keratoconus(KC)and KC suspect(KCS)in 10-to 30-year-old patients with Down s...Background:To assess the diagnostic ability of Pentacam HR(Oculus Optikgeräte,GmbH,Wetzlar,Germany)tomographic indices in discriminating keratoconus(KC)and KC suspect(KCS)in 10-to 30-year-old patients with Down syndrome(DS).Methods:In this study,DS patients were enrolled through special needs schools,the National Down Syndrome Society,and relevant non-profit organizations.Diagnoses were made independently by two experienced specialists.Forty Pentacam indices related to corneal thickness,volume,density,keratometry,power,shape,aberration,and elevation were extracted.For each index,the accuracy for KC and KCS diagnosis was evaluated using discriminant analysis and the area under receiver operating characteristic curve(AUROC).From each enrolled case,data from only one eye was entered in the analyses.Results:Analyses were performed on data from 25 KC,46 KCS,and 154 non-ectatic DS eyes.The best discriminants for KC were anterior higher order aberrations(HOA)(cutoff>0.643,AUROC=0.879),posterior vertical coma(cutoff>0.0702μm,AUROC=0.875),anterior vertical coma(cutoff>0.4124μm,AUROC=0.868),and total HOA(cutoff>0.608,AUROC=0.867).The difference between AUROCs were not statistically significant(all P>0.05).For KCS,the best discriminants were minimum corneal thickness(cutoff≤480.0μm,AUROC=0.775),corneal volume(cutoff≤55.3μm,AUROC=0.727)and Belin Ambrosio display-total deviation(BAD-D)(cutoff>2.23,AUROC=0.718)with no significant difference between AUROCs(all P>0.05).Conclusions:In this sample of DS patients,best KC discriminators were HOA and coma which showed good diagnostic ability.For KCS,best predictors were minimum corneal thickness,corneal volume,and BAD-D with relatively good diagnostic ability.Defining a new set of KC diagnostic criteria for DS patients is suggested.展开更多
Background:To assess the diagnostic ability of Pentacam HR(Oculus Optikgerate,GmbH,Wetzlar,Germany)tomographic indices in discriminating keratoconus(KC)and KC suspect(KCS)in 10-to 30-year-old patients with Down syndro...Background:To assess the diagnostic ability of Pentacam HR(Oculus Optikgerate,GmbH,Wetzlar,Germany)tomographic indices in discriminating keratoconus(KC)and KC suspect(KCS)in 10-to 30-year-old patients with Down syndrome(DS).Methods:In this study,DS patients were enrolled through special needs schools,the National Down Syndrome Society,and relevant non-profit organizations.Diagnoses were made independently by two experienced specialists.Forty Pentacam indices related to corneal thickness,volume,density,keratometry,power,shape,aberration,and elevation were extracted.For each index,the accuracy for KC and KCS diagnosis was evaluated using discriminant analysis and the area under receiver operating characteristic curve(AUROC).From each enrolled case,data from onlyoneeyewas entered intheanalyses.Results:Analyses were performed on data from 25 KC,46 KCS,and 154 non-ectatic DS eyes.The best discriminants for KC were anterior higher-order aberrations(HOA)(cutoff>0.643μm,AUROC=0.879),posterior vertical coma(cutoff>0.0702μm,AUROC=0.875),anterior vertical coma(cutoff>0.4124μm,AUROC=0.868),and total HOA(cutoff>0.608μm,AUROC=0.867).The difference between AUROCs were not statistically significant(all P>0.05).For KCS,the best discriminants were minimum corneal thickness(cutoff≤480.0μm,AUROC=0.775),corneal volume(cutoff≤55.3μm,AUROC=0.727)and Belin Ambrosio display-total deviation(BAD-D)(cutoff>2.23,AUROC=0.718)with no significant difference between AUROCs(all P>0.05).Conclusions:In this sample of DS patients,the best KC discriminators were HOA and coma which showed good diagnostic ability.For KCS,the best predictors were minimum corneal thickness,corneal volume,and BAD-D with relatively good diagnostic ability.Defining a new set of KC diagnostic criteria for DS patients is suggested.展开更多
文摘AIM:To compare the tear film quantity and stability parameters in keratoconus(KCN)and normal eyes using test breakup time(TBUT),noninvasive TBUT(NITBUT),and Schirmer test.METHODS:All participants(n=166),including patients with KCN and age-matched healthy individuals with normal corneas,were recruited from those referred to Farabi Eye Hospital,Iran,in 2023.To better account for genetic and environmental factors,the control group comprised healthy individuals who were relatives of KCN patients and had normal corneal topography.Tear quantity parameters were evaluated in the following order:NITBUT,TBUT,and Schirmer tests.RESULTS:The mean age of cases in KCN(61.7%males)and normal(63.5%males)participants was 27.54±5.44y(range 19 to 38)and 27.52±5.63y(range 20 to 38),respectively(P=0.976).NIBUT,TBUT,and Schirmer’s tests were significantly lower in KCN group compared to normal controls(all P<0.001).The mean difference for NIBUT was-7.81s(P<0.001),and for TBUT was-7.61s(P<0.001).Schirmer test values were also significantly lower in the KCN group,with a mean difference of-5.61 mm compared to normal people(P<0.001).CONCLUSION:Our findings demonstrate significant tear film impairment in KCN.The reductions in NIBUT,TBUT and Schirmer scores highlight an underlying tear film dysfunction in KCN that extends beyond the morphological changes of the cornea.
文摘AIM:To compare refractive error and angle of deviation in patients with basic esotropia and basic exotropia.METHODS:A retrospective review was conducted on the medical records of patients with basic-type strabismus.Demographic data,refractive error,best-corrected distance visual acuity(BCVA),and the horizontal and vertical angle of deviation between basic esotropia and exotropia patients were compared.RESULTS:Among the 7129 patients(mean age 22.98±14.81y)evaluated,44.7%(3185 cases,54.9%male)exhibited basic-type esotropia,while 55.3%(3944 cases,53.9%male)presented with basic-type exotropia.Basic esotropia cases exhibited more hyperopic spherical equivalent measurements in both eyes(right:0.53±3.07 vs left:0.56±2.98 D)than those with basic exotropia(right eye:-0.33±2.84 vs left eye:-0.24±2.68 D,P<0.001 for both eyes).Patients with basic esotropia had significantly greater horizontal deviation angles(near:36.08±18.87 PD and far:35.56±18.75 PD)compared to those with basic exotropia(near:33.75±16.11 PD and far:33.26±15.90 PD,P<0.001).Conversely,patients with basic exotropia had slightly higher vertical deviation angles(near:1.67±5.80 PD and far:1.72±5.89 PD)compared to those with basic esotropia(near:1.12±4.57 PD and far:1.12±4.58 PD,P<0.001).Patients with basic esotropia underwent surgical intervention at younger ages compared to basic exotropia individuals(19.68±15.99 vs 25.66±13.20,P<0.001).CONCLUSION:Basic esotropia patients present more hyperopic refractive errors,better visual acuity,larger horizontal yet smaller vertical ocular misalignments,and tend to undergo strabismus surgery at younger ages relative to basic exotropia cases.
基金Supported by National Institute for Medical Research Development(NIMAD)affiliated with the Iranian Ministry of Health and Medical Education(No.963660).
文摘AIM:To explore the prevalence of pterygium and pinguecula and their risk factors.METHODS:This population-based cross-sectional study was conducted on geriatric population aged 60 and over in Tehran,Iran from Jan 2019 to Jan 2020.Selected subjects were interviewed and subjected to optometric and ophthalmic examinations.RESULTS:The age and sex standardized prevalence of pterygium and pinguecula was 3.64%[95%confidence interval(CI):2.94%–4.49%]and 55.57%(95%CI:52.89%–58.22%),respectively.The prevalence of pterygium was 4.52%(95%CI:3.5%–5.81%)in men and 2.79%(95%CI:1.97%–3.94%)in women and the prevalence of pinguecula was 64.56%(95%CI:60.92%–68.03%)in men and 46.72%(95%CI:43.74%–49.72%)in women.According to the results of multiple logistic regression,pinguecula had a significant correlation with male sex[odds ratio(OR):2.21,95%CI:1.63–2.99]and education level(OR:0.52,95%CI:0.35-0.77)and pterygium had a significant relationship with male sex(OR:2.2,95%CI:1.38–3.52),socioeconomic status(SES,OR:0.5,95%CI:0.26–0.97),education level(OR:0.22,95%CI:0.08–0.61).CONCLUSION:The prevalence of pinguecula and pterygium in this study are lower than other studies.Sex,SES,and education level are the risk factors of the prevalence of pinguecula and pterygium.
文摘AIM:To compare objective dry retinoscopy and subjective refraction measurements in patients with mild keratoconus(KCN)and quantify any differences.METHODS:This cross-sectional study was done on 68 eyes of 68 patients diagnosed with mild KCN.Objective dry retinoscopy using autorefractometer and subjective refraction measurements were performed.Sphere,cylinder,J0,J45,and spherical equivalent values were compared between the two techniques.RESULTS:The mean age of 68 patients with mild KCN was 21.32±5.03y(12–35y).There were 37(54.4%)males.Objective refraction yielded significantly more myopic sphere(-1.44 D vs-0.57 D),higher cylinder magnitude(-2.24 D vs-1.48 D),and more myopic spherical equivalent(-2.56 D vs-1.31 D)compared to subjective refraction(all P<0.05).The mean differences were-0.87 D for sphere,-0.76 D for cylinder,and-1.25 D for spherical equivalent.No significant differences were found for J0 and J45 values,indicating agreement in astigmatism axis(P>0.05).CONCLUSION:In patients with mild KCN,objective dry retinoscopy overestimates the degree of myopia and astigmatism compared to subjective refraction.The irregular cornea in KCN likely impacts objective measurements.Subjective refraction allows compensation for irregularity,providing a more accurate correction.When determining refractive targets,the tendency of objective methods to overcorrect should be considered.
文摘AIM:To identify differences in clinical features between thyroid eye disease(TED)patients with and without strabismus.METHODS:This retrospective,single-center,consecutive case series study was conducted on TED patients who were determined to be surgical candidates.The patients’cohort were divided into two groups based on the presence or absence of strabismus.Demographics and complete eye examinations were recorded and compared between the TED and TED with strabismus groups.RESULTS:A total of 76 patients with TED were enrolled,including 58 males(76.3%)with a mean age of 52.68±10.45y.The 55 patients(male:female=2:1)were found to have TED with strabismus,while the remaining 21 patients(male:female=4:1)had TED without strabismus.There was nearly a four times greater likelihood of lid retraction being associated with TED without strabismus(OR=4.1,P=0.018)and they showed higher prevalence of proptosis(95.2%)than the TED strabismus group(63.6%,P<0.001).In the TED-strabismus group,20%of patients had abnormal head posture(AHP),while none were identified in the TED group(P=0.029).Despite the higher incidence of vision-threatening complications such as dysthyroid optic neuropathy(19%vs 8.1%)and exposure keratopathy(4.8%vs 1.8%)in the TED group than in the TED-strabismus group,the difference did not reach statistical significance(P>0.05).The most common types of strabismus were hypotropia(36%)and esotropia(29%),respectively.CONCLUSION:Strabismus-associated TED is characterized by a lower prevalence of proptosis and lid retraction,but a higher incidence of compensatory AHP.Identifying these differences may aid in risk stratification and early intervention for TED patients,particularly those at risk for restrictive strabismus.
文摘This narrative review aimed to have an algorithmic approach to microphthalmos by a systematic search.The definition can be related to a number of special phenotypes.In the more challenging cases of complex microphthalmos,relative anterior microphthalmos,and nanophthalmos,the surgeon can approach these cases more safely if they have a deep understanding of the anatomical variations and ideal formulae for intraocular lens computation and knows how to avoid intra-and post-operative complications.In this article,we review the criteria by which we recognize and describe pre-,intra-,and post-operative considerations,as well as discuss the ideal intraocular lenses for microphthalmos,given the intricate varieties of small eye phenotypes.
文摘AIM:To compare outcomes of applying preservative free artificial tears(PFAT)with and without hyaluronic acid(HA)in early postoperative course following photorefractive keratectomy(PRK).METHODS:In this triple-blinded randomized clinical trial,PRK procedure was performed on both eyes of 230 patients.Following PRK,patients were divided into three groups:the HA^(+)group,44 patients PFAT containing HA;the HA-group,71 patients PFAT without HA were administered 5 times per day(every 4 h);the third group,115 patients received no PFAT before lens removal.On the 1st and 4th postoperative day,Visual Analogue Score(VAS)was utilized to evaluate patient’s level of pain.Participants were asked to complete a questionnaire about the severity of eye discomfort ranked from 0 to 10(0=no complaint;10=most severe complaint experienced).RESULTS:In eyes receiving PFAT with or without HA(Drop group),mean scores for epiphora,foreign body sensation,and blurred vision on the 1st postoperative day were statistically lower(P<0.05).Filamentous keratitis(FK)was detected in 11(4.7%)eyes,and recurrent corneal erosion(RCE)was observed in 5(2.1%)eyes.In the control group,FK was noted in 16(6.9%)eyes while 13(5.6%)eyes had RCE and 5(2.1%)eyes had corneal haze.The rate of complications was statistically lower in Drop group(P=0.009).However,the aforementioned scores were not statically different between HA^(+)and HA-group one and two(P=0.29).CONCLUSION:Following PRK,applying PFAT with and without HA yields faster visual recovery,decreases postoperative ocular discomfor t and haze formation;however there is no additive effect for HA.
文摘AIM:To evaluate the effect of axial length(AL)and anterior chamber depth(ACD)on peripheral refractive profile in myopic patients compared to emmetropic participants.METHODS:This cross-sectional study was conducted in right eyes of 58 participants of whom 38 were emmetropic and 20 were myopic.Central and peripheral refraction were measured at 10°,20°,and 30°eccentricities in nasal and temporal fields using an open-field autorefractor.The Lenstar LS900 was used to measure ACD and AL.The participants were divided into three groups of short(<22.5 mm),normal(22.5-24.5 mm),and long eye(>24.5 mm)according to AL and three groups of low ACD(<3.00 mm),normal ACD(3.00-3.60 mm),and high ACD(>3.60 mm)according to ACD.RESULTS:The mean age of the participants was 22.26±3.09 y(range 18-30 y).The peripheral mean spherical refractive error showed a hypermetropic shift in myopic and emmetropic groups although this shift was more pronounced in the myopic group.The results showed significant changes in the spherical equivalent,J0,and J45 astigmatism in all gazes with an increase in eccentricity(P<0.001).The pattern of refractive error changes was more noticeable in long and short eyes versus normal AL eyes.Moreover,the pattern of peripheral refractive changes was much more prominent in the high ACD group versus the normal ACD group and in the normal ACD group versus the low ACD group.CONCLUSION:Peripheral refraction changes are greater in participants with AL values outside the normal range and deeper ACD values compared to participants with normal AL and ACD.
基金Supported by the Deputy of Health of Iranian Ministry of Health(No.1602005000)。
文摘AIM:To conduct a cost-utility analysis of the teleretinopathy of prematurity(ROP)screening program against no screening.METHODS:A decision tree model was developed to identify and treat the infants with threshold ROP through the tele-screening system compared with no screening program from the societal perspective.We used the quality adjusted life years(QALY)index to measure the scenarios’effectiveness,which was discounted for the future years by 0.058.One hundred twenty-six randomly selected newborns with ROP required treatment were investigated to extract the treatment information.We considered the direct medical and non-medical costs in cost calculations analysed by the bottom-up approach.The figures of the model’s inputs were calculated using the Monte Carlo simulation that generated 1000 random iteration of the data,and a one-way sensitivity analysis was performed on the model to cope with the potential uncertainties.RESULTS:The total and per capita needed the budget to establish a tele-ROP screening system were estimated at over 1.5 million and 35.13 USD,respectively.The total cost of identifying and treating an ROP case in tele-screening and no screening strategies were obtained as 108.72 and 63.52 USD,respectively,and their lifetime discounted QALY gained were calculated as 15.39 and 15.11,respectively.Therefore,incremental cost-effectiveness ratio(ICER)of tele-screening strategy against the competitive strategy was achieved as 161.43 USD.CONCLUSION:Tele-ROP screening program is one of the most cost-effective interventions in the Iranian health system and has a high priority to receive a budget for implementation.
文摘Dear Editor,We have presented the clinical findings of a case with bilateral early-onset central toxic keratopathy(CTK) followed by bilateral late-onset post-LASIK keratectasia. Laser in situ keratomileusis(LASIK) is a safe procedure to treat a broad spectrum of refractive errors;however, unexpected and rarely encountered post-LASIK complications could be a challenge for patient and surgeon.
基金Supported by National Institute for Medical Research Development (NIMAD) affiliated with the Iranian Ministry of Health and Medical Education (No.963660)。
文摘AIM:To determine the distribution and associated factors of intraocular pressure(IOP) in an Iranian elderly population 60 years of age and above.METHODS:The present report is part of the Tehran Geriatric Eye study(TGES),a population-based cross-sectional study that was conducted on the residents of Tehran 60 years of age and above.The sampling was performed using multistage stratified random cluster sampling methods from 22 districts of Tehran,Iran.Demographic and history information,blood samples,and blood pressure were collected from all participants.Ocular examinations included measurement of uncorrected and best-corrected visual acuity,objective and subjective refraction,and slit-lamp biomicroscopy.The IOP was measured using Goldmann applanation tonometry(GAT).Corneal imaging and ocular biometry were performed using Pentacam AXL.RESULTS:The data of 3892 eyes of 2124 individuals were analyzed for this report.The mean age of the study participants was 66.49±5.31y(range:60 to 95y).The mean IOP was 15.2 mm Hg(95%CI:15.1 to 15.4),15.3 mm Hg(95%CI:15.1 to 15.5) and 15.1 mm Hg(95%CI:15.0 to 15.3) in all participants,males,and females,respectively.Of the study participants,1.3% had an IOP of ≥20 mm Hg.The mean IOP increased from 15.1 mm Hg in the age group 60-64y to 16.3 mm Hg in the age group ≥80y.According to the final multiple GEE model,the IOP was statistically significantly higher in men than in women.All the studied age groups,except for the 75-79-year-old age group,had significantly higher IOP compared to the 60-64-year-old age group.The IOP was significantly higher in underweight compared to other body mass index groups.Moreover,the IOP had a statistically significant direct relationship with the mean corneal power(mean CP),central corneal thickness(CCT),and systolic blood pressure.CONCLUSION:The present study presents the distribution of IOP in an Iranian elderly population.A higher IOP(within the range 14 to 17 mm Hg) is significantly associated with older age,male sex,high systolic blood pressure,increased mean CP,and CCT.These factors should be considered in the clinical interpretation of IOP.
基金Supported by National Institute for Medical Research Development(NIMAD)Affiliated with the Iranian Ministry of Health and Medical Education(No.963660).
文摘AIM:To determine the prevalence of some retinal pathologies in people over 60y and their association with demographic and ocular factors.METHODS:A cross-sectional study was conducted in Tehran using multistage cluster sampling.After selecting subjects aged 60 and over,optometric,and ophthalmic examinations were done.For retinal examination,a 90 D lens was used and indirect ophthalmoscopy was performed after instilling tropicamide drops.Biometry was done using the IOL Master for all participants.RESULTS:Of 3791 people that were invited through cluster sampling,3310 participated in the study(response rate=82%).The prevalence of retinal pigmented epithelium(RPE)change,drusen,geographic atrophy(GA),hypertensive retinopathy(HTR),nonproliferative diabetic retinopathy(NPDR),proliferative diabetic retinopathy(PDR),choroidal neovascularization(CNV),central retinal artery occlusion(CRAO),myopic retinopathy(MR),branch retinal vein occlusion(BRVO),and central retinal vein occlusion(CRVO)was 27.42%,11.08%,4.52%,3.03%,4.05%,0.54%,0.82%,0.39%,0.20%,0.49%,and 0.19%,respectively.After removing the effect of age,the odds of NPDR were 1.68 times higher in women compared to men(P=0.014).After removing the effect of sex,the odds of drusen,RPE change,GA,CNV,BRVO,and CRVO increased with age.CONCLUSION:There is a higher prevalence of RPE change,drusen,GA,CNV and a lower prevalence of MR and CRAO in the elderly population of Tehran aged over 60y compared to global average values.Considering the correlation of most of the diseases with age and their effects on vision,attention should be paid to these diseases and the related screening programs to prevent vision impairment.
文摘Background:To assess the diagnostic ability of Pentacam HR(Oculus Optikgeräte,GmbH,Wetzlar,Germany)tomographic indices in discriminating keratoconus(KC)and KC suspect(KCS)in 10-to 30-year-old patients with Down syndrome(DS).Methods:In this study,DS patients were enrolled through special needs schools,the National Down Syndrome Society,and relevant non-profit organizations.Diagnoses were made independently by two experienced specialists.Forty Pentacam indices related to corneal thickness,volume,density,keratometry,power,shape,aberration,and elevation were extracted.For each index,the accuracy for KC and KCS diagnosis was evaluated using discriminant analysis and the area under receiver operating characteristic curve(AUROC).From each enrolled case,data from only one eye was entered in the analyses.Results:Analyses were performed on data from 25 KC,46 KCS,and 154 non-ectatic DS eyes.The best discriminants for KC were anterior higher order aberrations(HOA)(cutoff>0.643,AUROC=0.879),posterior vertical coma(cutoff>0.0702μm,AUROC=0.875),anterior vertical coma(cutoff>0.4124μm,AUROC=0.868),and total HOA(cutoff>0.608,AUROC=0.867).The difference between AUROCs were not statistically significant(all P>0.05).For KCS,the best discriminants were minimum corneal thickness(cutoff≤480.0μm,AUROC=0.775),corneal volume(cutoff≤55.3μm,AUROC=0.727)and Belin Ambrosio display-total deviation(BAD-D)(cutoff>2.23,AUROC=0.718)with no significant difference between AUROCs(all P>0.05).Conclusions:In this sample of DS patients,best KC discriminators were HOA and coma which showed good diagnostic ability.For KCS,best predictors were minimum corneal thickness,corneal volume,and BAD-D with relatively good diagnostic ability.Defining a new set of KC diagnostic criteria for DS patients is suggested.
文摘Background:To assess the diagnostic ability of Pentacam HR(Oculus Optikgerate,GmbH,Wetzlar,Germany)tomographic indices in discriminating keratoconus(KC)and KC suspect(KCS)in 10-to 30-year-old patients with Down syndrome(DS).Methods:In this study,DS patients were enrolled through special needs schools,the National Down Syndrome Society,and relevant non-profit organizations.Diagnoses were made independently by two experienced specialists.Forty Pentacam indices related to corneal thickness,volume,density,keratometry,power,shape,aberration,and elevation were extracted.For each index,the accuracy for KC and KCS diagnosis was evaluated using discriminant analysis and the area under receiver operating characteristic curve(AUROC).From each enrolled case,data from onlyoneeyewas entered intheanalyses.Results:Analyses were performed on data from 25 KC,46 KCS,and 154 non-ectatic DS eyes.The best discriminants for KC were anterior higher-order aberrations(HOA)(cutoff>0.643μm,AUROC=0.879),posterior vertical coma(cutoff>0.0702μm,AUROC=0.875),anterior vertical coma(cutoff>0.4124μm,AUROC=0.868),and total HOA(cutoff>0.608μm,AUROC=0.867).The difference between AUROCs were not statistically significant(all P>0.05).For KCS,the best discriminants were minimum corneal thickness(cutoff≤480.0μm,AUROC=0.775),corneal volume(cutoff≤55.3μm,AUROC=0.727)and Belin Ambrosio display-total deviation(BAD-D)(cutoff>2.23,AUROC=0.718)with no significant difference between AUROCs(all P>0.05).Conclusions:In this sample of DS patients,the best KC discriminators were HOA and coma which showed good diagnostic ability.For KCS,the best predictors were minimum corneal thickness,corneal volume,and BAD-D with relatively good diagnostic ability.Defining a new set of KC diagnostic criteria for DS patients is suggested.
