Ophthalmic and Vision Research

Visual impairment in kurdistan and trend of epidemiologic eye studies in Iran Per Kallestrup Journal of Ophthalmic and Vision Research 2019 14(2):123-124

Indications and surgical techniques for corneal transplantation at a tertiary referral center Hossein Jamali, Ahmad Reza Gholampour Journal of Ophthalmic and Vision Research 2019 14(2):125-130 Purpose: The study aimed to review the indications and techniques for corneal transplantation at a tertiary referral center over a 5-year period. Methods: Records of patients who underwent corneal transplantation at Khalili Medical Center, Shiraz, Iran from September, 2012 to September, 2017 were reviewed. Results: A total of 1149 eyes of 956 patients underwent corneal transplantation. The most common indication was infectious corneal ulcers (n = 296, 25.8%), followed by keratoconus (n = 243, 21.1%), bullous keratopathy (n = 219, 19.1%), failed grafts (n = 117, 10.2%), non-herpetic corneal scars (n = 113, 9.8%), corneal stromal dystrophies (n = 33, 2.9%), pellucid marginal degeneration (n = 31, 2.7%), and trauma (n = 26, 2.3%); other indications included thin descemetocele, post-herpetic corneal scar, endothelial corneal dystrophies, anterior segment dysgenesis, corneal ectasia after laser in situ keratomileusis, and corneal fibrosis. Corneal transplantation techniques included penetrating keratoplasty (PKP, n = 789, 68.7%), deep anterior lamellar keratoplasty (DALK, n = 187, 16.3%), Descemet's stripping automated endothelial keratoplasty (n = 171, 14.9%), and keratolimbal allograft (n = 2, 0.1%) in descending order. In children (aged ≤18 years), the most common indication was keratoconus (n = 32, 41.6%), and the most common technique was PKP (n = 50, 64.9%). In patients aged 19-27 years, the most common indication was keratoconus (n = 89, 64.5%), and the most common technique was PKP (n = 75, 54.4%). Conclusion: Infectious corneal ulcer was the most common indication, and PKP was the most prevalent technique in patients undergoing corneal transplantation. DALK was an emerging alternative surgical treatment in patients with corneal disorders in which corneal endothelium is spared.

Autologous platelet-rich plasma eye drops accelerate re-epithelialization of post-keratoplasty persistent corneal epithelial defects Shaban Alizadeh, Sahar Balagholi, Alireza Baradaran-Rafii, Siamak Delfaza-Baher, Sare Safi, Hamid Safi, Rasul Dabbaghi, Mozhgan Rezaei Kanavi Journal of Ophthalmic and Vision Research 2019 14(2):131-135 Purpose: To investigate whether autologous platelet-rich plasma (PRP) eye drops accelerate re-epithelialization of post-keratoplasty persistent corneal epithelial defects (PEDs). Methods: A total of 34 eyes with PEDs after keratoplasty (24 penetrating keratoplasty and 10 deep anterior lamellar keratoplasty) that were refractory to conventional medical treatments were treated with PRP eye drops every 3 hours. PRP eye drops were prepared with a low- and high-speed centrifugation method and final platelet counts were 700,000-800,000 plt/μl. The mean treatment duration for complete re-epithelialization was compared with the mean treatment duration of conventionally treated corneal defects before the PRP treatment by paired t-test. The mean treatment duration was also statistically analyzed between age groups, gender, indications for keratoplasty, and types of keratoplasty using analysis of variance (ANOVA). Results: Treatment with autologous PRP eye drops led to rapid re-epithelialization in all eyes. The mean treatment duration for complete re-epithelialization was 2.47 ± 1.21 weeks, which was significantly shorter than the mean treatment duration of conventionally treated corneal defects before PRP treatment (6.82 ± 1.24 weeks) (P = 0.0001). There was no significant correlation between re-epithelialization time and patients' age, sex, indications for keratoplasty, and techniques of corneal transplantation. Conclusion: Treatment with autologous PRP eye drops is an effective and reliable approach that accelerates re-epithelialization of post-transplantation PEDs.

Efficacy of autologous serum in fixing conjunctival autografts of various sizes in different types and grades of pterygium Shreya Thatte, Ankita B Dube, Stuti Sharma Journal of Ophthalmic and Vision Research 2019 14(2):136-143 Purpose: To evaluate the efficacy of autologous serum in fixing conjunctival autografts of various sizes in different grades and types of pterygium and to determine the largest successfully secured graft size. Methods: This prospective interventional study comprised 151 eyes of 151 patients belonging to age group of 21 to 64 years with different grades and types of primary and recurrent pterygium that underwent excision with inferior conjunctivo - limbal autograft secured with autologous serum. The autografts were measured with calipers and were grouped by size into three categories: Group A, small (5 × 5 mm); Group B, medium (5–7 × 5 mm); and Group C, large (>7 × 5 mm). The adhesive fixation power of autologous serum for the various conjunctival autograft sizes was determined for each group using the following criteria: graft stability, cosmetic appearance and complications in the immediate ( first week) and two-months postoperative follow-up visits. Descriptive statistical analysis was used to calculate the percentage frequency of the variables. Results: The groups A, B, and C included 48%, 22%, and 30% of the autografts, respectively. Overall, 93.34% of the grafts were stable with good cosmetic appearance. However, subconjunctival hemorrhage (36%), graft edema (36%) and graft retraction (13.5%) were the most common complications. The largest successfully fixed graft was 14 × 5 mm in size. Conclusion: Autologous serum is efficient in securing conjunctival autografts of various sizes with minimal complications and satisfactory results, including good cosmesis.

Modified deep sclerectomy for the surgical treatment of glaucoma Farideh Sharifipour, Shahin Yazdani, Mona Asadi, Azadeh Saki, Kouros Nouri-Mahdavi Journal of Ophthalmic and Vision Research 2019 14(2):144-150 Purpose: To report the short-term outcomes of modified deep sclerectomy (MDS) in the management of open angle glaucoma. Methods: This prospective, non-randomized, controlled study included 105 eyes (105 patients) with open angle glaucoma. Eyes were categorized as follows: trabeculectomy (30 eyes), MDS (27 eyes), phacotrabeculectomy (28 eyes), and phaco-MDS (20 eyes). The MDS technique involved removal of a third scleral flap to expose the suprachoroidal space and excision of a trabecular block. A two-site approach was used for combined surgeries. Main outcome measures included intraocular pressure (IOP), number of glaucoma medications, and complications. Treatment success was defined as an IOP of 6–15 mmHg and/or a 30% reduction in IOP. Results: All groups showed significant decrease in IOP and number of medications (both P s < 0.001). The MDS group had a higher IOP (13.9 ± 3.8 vs. 12.4 ± 2.5 mmHg, P = 0.080) and required more medications (P = 0.001) than the trabeculectomy group at 1 year. The MDS group had a higher baseline IOP than the trabeculectomy group (P = 0.004) and both the groups showed similar IOP reductions (33.3% vs. 25.7%, P = 0.391). The phaco-MDS and phacotrabeculectomy groups had comparable IOP (13.3 ± 3.1 vs. 12.4 ± 3.1 mmHg, P = 0.354), number of medications (P = 0.594), and IOP reduction (P = 0.509) at 1-year follow-up visit. The trabeculectomy and phacotrabeculectomy groups developed more wound leaks (P = 0.043) and required more bleb needling during the early postoperative period (P < 0.001). Conclusion: The MDS technique seems to be slightly inferior to trabeculectomy, but when combined with phacoemulsification, is safer and results in similar IOP outcomes.

Effect of intravitreal bevacizumab injection on corneal in vivo biomechanics: A pilot study Nasser Shoeibi, Mohammad-Reza Ansari-Astaneh, Mohammad Reza Sedaghat, Saeed Shokoohi Rad Journal of Ophthalmic and Vision Research 2019 14(2):151-156 Purpose: To evaluate the effect of intravitreal bevacizumab (IVB) injection on corneal biomechanical parameters as measured by the ocular response analyzer (ORA) and Corneal Visualization Scheimpflug Technology (CorVis). Methods: In this prospective pilot study, ORA and CorVis parameters were recorded before and after a three-month course of IVB injection therapy in 16 patients in the injected and the contralateral non-injected control eyes. The changes in the recorded parameters in each group and the differences between the two groups were evaluated and compared. Results: None of the changes in ORA parameters were statistically significant in the injected and non-injected groups before and three months after injection, except for corneal resistance factor (CRF) in injected eyes (paired t-test, P = 0.039). The differences in corneal hysteresis (CH) and CRF were not statistically significant between the two groups (P = 0.441 and 0.236, respectively), but significant differences were noted between corneal compensated IOP (IOPcc) and Goldmann-correlated IOP (IOPg) (P = 0.045 and 0.047, respectively). None of the changes in CorVis parameters were statistically significant in the groups before and at the end of study, except for the time of first corneal applanation (TAp1 ms) in the injected group (P = 0.040, paired t-test). Differences in TAp1, length of the second corneal applanation (LAp2 mm), velocity of the second corneal applanation (VAp2 m/s), intraocular pressure (IOP), and central corneal thickness (CCT) also showed borderline significance between the two groups. Conclusion: In this pilot study IVB injection could change CRF, IOPcc, IOPg, and TAP1 as measured by ORA and CorVis.

The effect of panretinal photocoagulation (PRP) versus intravitreal bevacizumab (IVB) plus prp on peripapillary retinal nerve fiber layer (RNFL) thickness analyzed by optical coherence tomography in patients with proliferative diabetic retinopathy Ramak Roohipour, Elahe Sharifian, Sasan Moghimi, Masoud Aghsaei Fard, Fariba Ghassemi, Mohammad Zarei, Samaneh Davoodi, Fatemeh Bazvand, Bobeck S Modjtahedi Journal of Ophthalmic and Vision Research 2019 14(2):157-163 Purpose: The current study aimed to evaluate changes in peripapillary retinal nerve fiber layer (RNFL) thickness in diabetic patients with bilateral proliferative diabetic retinopathy (PDR) after receiving panretinal photocoagulation (PRP) or intravitreal bevacizumab (IVB) with PRP. Methods: Ocular examination and peripapillary optical coherent tomography (OCT) were performed for each patient at baseline, 1, 3, 6, and 10 months after treatment. Both eyes of each patient were randomized into either PRP or PRP + IVB group. Results: Sixty-four eyes (32 patients) were enrolled in this randomized clinical trial. In the PRP group, global RNFL thickness initially increased and reached statistical significance in the third month (from 105.9 ± 21.4μm at baseline to 119 ± 41.6μm at 3 months, P = 0.03). Subsequent decline was observed with no significant difference from baseline at 10 months (106 ± 19.3μm, P = 0.914). There were no statistically significant changes in the PRP + IVB group (from 101.7 ± 22.2μm at baseline to 109.3 ± 26.9μm at 3 months, P = 0.996 and 101.9 ± 16.5μm at 10 months, P = 0.999). In the latter group, slight increase in RNFL thickness was observed in the first month (107.7 ± 21.1μm). RNFL thickness was similar to baseline in the two groups at month 10, with the exception of significant increase in superior-temporal sector in the PRP group (145.3 ± 13.4μm vs. 127.2 ± 17.3μm, P = 0.045). Conclusion: Compared to eyes treated with PRP, eyes treated with adjunctive IVB showed less significant post-treatment changes in RNFL thickness.

Evaluation of choroidal layer thickness in central serous chorioretinopathy Daren Hanumunthadu, Elon H C van Dijk, Sunila Dumpala, Bindu Rajesh, Ayesha Jabeen, Asiya Jabeen, Momin Ansari, Pooja Mehta, Shilpi Shah, Chintan Sarvaiya, Catherine Meyerle, Lihteh Wu, Alay Banker, Camiel J Boon, Jay Chhablani Journal of Ophthalmic and Vision Research 2019 14(2):164-170 Purpose: To evaluate medium and large choroidal vessel layer thickness (MCVT and LCVT, respectively) in eyes with acute and chronic central serous chorioretinopathy (CSC) in comparison with age-matched controls. Methods: The study included 96 eyes of 96 patients with CSC, including 53 eyes with acute CSC, 43 eyes with chronic CSC, and 30 eyes of 30 age-matched normal subjects. Manual measurements of subfoveal choroidal thickness (SFCT), MCVT, and LCVT at subfoveal and 750 μm nasal and temporal to the fovea locations were made on enhanced depth imaging optical coherence tomography (EDI-OCT) of the macula in all subjects using ImageJ software (National Institutes of Health, Bethesda, MD, USA). Results: SFCT in acute CSC was significantly larger than that in healthy eyes (P = 0.0001). SFCT in acute CSC did not differ significantly from that in chronic CSC eyes. Subfoveal LCVT and MCVT in acute CSC eyes were greater than those in healthy eyes (P = 0.02 and P = 0.03, respectively). Mean SFCT and MCVT in chronic CSC eyes were significantly larger than those in control eyes (P = 0.01 and P = 0.04, respectively). No significant difference in LCVT was observed between chronic and control eyes. Conclusion: Choroidal vasculature is altered in both acute and chronic CSC. SFCT, MCVT, and LCVT are higher in eyes with acute CSC. The thickening of medium choroidal vessels is still detectable in chronic CSC compared to control eyes.

Detection of FZD4, LRP5 and TSPAN12 genes variants in Malay premature babies with retinopathy of prematurity Siti Zulaikha Nashwa Mohd Khair, Abdul Salim Ismail, Zunaina Embong, Abdul Aziz Mohamed Yusoff Journal of Ophthalmic and Vision Research 2019 14(2):171-178 Purpose: To determine the mutational analyses of familial exudative vitreoretinopathy (FEVR)-causing genes in Malay patients with retinopathy of prematurity (ROP) to obtain preliminary data for gene alterations in the Malay community. Methods: A comparative cross-sectional study involving 86 Malay premature babies (ROP = 41 and non-ROP = 45) was performed from September 2012 to December 2014. Mutation analyses in (FEVR)-causing genes (NDP, FZD4, LRP5, and TSPAN12) were performed using DNA from premature babies using polymerase chain reaction (PCR) and direct sequencing. Sequencing results were confirmed with PCR-Restriction Fragment Length Polymorphism (RFLP). Results: We found variants of FZD4, LRP5, and TSPAN12 in this study. One patient from each group showed a non-synonymous alteration in FZD4, c.502C>T (p.P168S). A synonymous variant of LRP5 [c.3357G>A (p.V1119V)] was found in 30 ROP and 28 non-ROP patients. Two variants of TSPAN12, c.765G>T (p.P255P) and c.*39C>T (3′UTR), were also recorded (29 and 21 in ROP, 33 and 26 in non-ROP, respectively). Gestational age and birth weight were found to be significantly associated with ROP (P value < 0.001 and 0.001, respectively). Conclusion: Analysis of data obtained from the ROP Malay population will enhance our understanding of these FEVR-causing gene variants. The c.3357G>A (p.V1119V) variant of LRP5, and c.765G>T (p.P255P) and c.*39C>T variants of TSPAN12 could be common polymorphisms in the Malay ethnic group; however, this requires further elucidation. Future studies using larger groups and higher numbers of advanced cases are necessary to evaluate the relationship between FEVR-causing gene variants and the risk of ROP susceptibility in Malaysian infants.

Rapid assessment of avoidable blindness in Kurdistan, Iran Elham Ashrafi, Seyed-Farzad Mohammadi, Marzieh Katibeh, Ebrahim Ghaderi, Cyrus Alinia, Naser Nourmohammadi, Alireza Lashay, Ramin Beiranvand, Mahsa Yousefpour Marzbali, Ali Sadeghi Tari Journal of Ophthalmic and Vision Research 2019 14(2):179-184 Purpose: To determine the magnitude and causes of blindness and visual impairment (VI) in Kurdistan, using the Rapid Assessment of Avoidable Blindness methodology. Methods: In this population-based cross sectional study, 99 clusters were selected through probability proportional to size sampling. Visual acuity (VA) was measured using a standard tumbling “E” chart. Ophthalmologists examined participants with VA < 6/18 in both eyes. The cause of VI in the better eye or the most treatable cause was considered as the primary cause of VI. Results: A total of 3203 (response rate: 92.4%) individuals aged 50 years and older participated, of whom 1657 (51.7%) were female. The standardized prevalence of blindness, severe visual impairment (SVI), and moderate visual impairment (MVI) based on available correction (presenting VA) were 2.1% (1.5-2.6), 1.7% (1.2-2.2), and 9.6%(8.4-10.8), respectively. The proportion of avoidable causes of blindness, SVI, and MVI were 58.1%, 78.4%, and 83.4%, respectively. The most common cause of blindness and SVI was cataract (27.4% and 60.8% respectively), followed by age-related macular degeneration (25.8% and 13.7%, respectively). The leading causes of MVI were uncorrected refractive errors (RE) (37.2%) and cataract (33.6%). Conclusion: The prevalence of blindness in the study population seems comparable to the region. According to our results, blindness, SVI, and MVI were mostly due to avoidable causes. Cataract and refractive errors are the principal causes of blindness and VI in Kurdistan.