Objective: Nearly one billion Muslims fast every year during the month of Ramadan. They refuse to drink, eat, or smoke during the fasting time. Regarding the changes in the lunar calendar, religious fasting time could range from 11 to 17 hours a day. It is not completely understood how fasting may effect on eye. Nevertheless, depending on the duration of fasting, different effects may occur in the eye. These effects may vary from choroidal and retinal blood flow changes to alteration in their vascular density. Optical coherence tomography angiography (OCTA) is a noninvasive method that provides both blood flow and structural information on retinal and choroidal layers. This new imaging modality established its clinical value in management of many eye diseases. However, OCTA is still a new technique and further studies required to determine the utility of this modality in the clinical setting. To our knowledge, only few studies evaluated the effect of fasting on retina. We conducted this study to evaluate the effect of religious fasting on vascular structures of macula and optic nerve using OCTA.

Methods & Materials: We enrolled 31 healthy volunteers from Khatam-al-Anbia Eye Hospital (Mashhad- Iran) during month of Ramadan. Participants fasted about 15 hours during a day and had pre-dawn meal and drink. All measurements were obtained by a single experienced technician with one device. Measurements for each subject, were performed between 8:00 to 9:00, and 18:00 to 19:00. The first examination was conducted about 3 to 4 hours after pre-dawn meal and it represents the non-fasting time. The second examination is conducted in the evening, about 15 hours after fasting. No medication for pupil dilation was used and imaging signal quality of ≥ 0.50 was considered acceptable.

Results: We assessed a total of 61 eyes from 31 healthy volunteers (21 men and 10 women) with the mean age of 32.87 ± 8.07, ranging from 23 to 54 years old. A significant decrease was found in the median intraocular pressure (IOP) before fasting time in the morning 12.00 (11.00, 13.00) in comparison with evening 10.00 (10.00, 11.00), with a p-value of <0.0001. Retinal peripapillary capillary (RPC) whole vascular density (VD), RPC inside VD, and RPC peripapillary VD mean values showed a significant decrease in the morning comparing to evening values (P-value = 0.011, 0.012,and 0.032 respectively). RPC whole image all, RPC inside disk all, and RPC peripapillary all mean values also showed significant decrease after fasting period with the p-values of 0.025, <0.0001, and 0.003, respectively. 

Conclusion: Religious fasting could reduce IOP significantly comparing to non-fasting period. It can also significantly decrease some of the macular and peripapillary vascular parameters. It can also reduce the Choroidoretinal flow area.

Keywords: Religious fasting, OCT-A, optic nerve, macula

Objective: Strabismus surgery is performed in children to correct vision and in adults only for cosmetic purposes. Postoperative pain reduction is one of the issues that has always been a challenge for researchers.

Methods & Materials: To conduct this study in 1399 in Khatam Al-Anbia Hospital in Mashhad, 30 patients with strabismus over 7 years of age undergoing R&R, BMR, BLR surgery by one surgeon. At the end of the operation, 1μg/kg of patient weight were given into the dexmedetomidine drug. Pain and discomfort were assessed based on the questionnaires. The same amount of normal saline was in 30 patients for control. The two groups were matched based on age, sex and weight. People who needed painkillers during the study were excluded from the study.

Results: According to the obtained data, due to the lack of difference in 4, 8, 12, 24, 48 hours, the efficacy of the drug in these times was not significantly different between the control and study groups. According to the information obtained, the highest pain time was seen in 8 hours after surgery and the lowest pain was seen in 48 hours after surgery.

Conclusion: No analgesic effect was seen in the following hours.

Keywords: Strabismus, Pain, Dexmedetomidine

Propose: Comparison of corneal biomechanical factors before and Three months after phacotrabeculectomy using Corvis device.

Methods & Materials:  During this longitudinal study, thirty patients with glaucoma who were in the age range of 40-70 years and were candidates for phacotrabeculectomy with no history of ophthalmic surgery and ocular problems other than glaucoma and cataract were included in the research. Exclusion criteria includes intraoperative or postoperative complication. One patient was excluded because of intraoperative complication.

Patients were enrolled in this study based on inclusion criteria and after obtaining informed consent. Demographic information including age, sex and history of systemic diseases, ophthalmic diseases and history of previous ophthalmic surgeries and medications were also recorded on data collection sheet.

The procedure was explained to the patients. Patients were evaluated preoperatively and three months postoperatively. Corneal biomechanical factors measured by Corvis device preoperatively and three months postoperatively . As well ophtalmological exams including measurement of BCVA, measurement of cup to disk ratio and tonometry with Goldmann  were done preoperatively and three months postoperatively. The results were compared using Paired Sample T Test  and Wilcoxon Signed Ranks Test.

Results: In this study, 29 patients including 16 males (55.2%) and 13 females (44.8%), with a mean age of (61.21±8.19) participated.

Among the biomechanical factors studied with preoperative control, Goldmann IOP, BCVA, drug number, app1velocity, app1length, pachymetry, D/A ratio, and HC deformation amplitude were significantly different preoperatively and three months postoperatively . Which were (P<0.001, P<0.001, P<0.001  , P=.01, P=.02, P=.02, P=.03, P=.01, P=.002 )

Conclusion: The results of this longitudinal study showed that some of the corneal biomechanichal factors have changed after phacotraeculectomy.

Objective: endophthalmitis after vitrectomy is a rare phenomenon that is rarer than endophthalmitis after cataract surgery. Various visual outcomes are reported and most of them suggest poor outcome for this disease. The aim of this study is to assess the underlying causes, outcomes, and frequency of endophthalmitis after vitrectomy in Khatam-ol-Anbia Hospital between 2011 and 2017

Methods & Materials: In a retrospective study, documents of the patients with endophthalmitis after vitrectomy between 2011 and 2017 were reviewed and data of the patients with acute endophthalmitis (less than 6 weeks) were included. Extracted data were gender, age, underlying disease, the diagnosis before surgery, diagnosis after surgery, and the type of surgery. Furthermore, visual acuity, lens condition, and retina condition were compared before surgery, during endophthalmitis, and after surgery. All the comparisons were done using SPSS software. p values under 0.05 were considered significant.

Results: Totally, 12 patients were enrolled. The incidence of endophthalmitis was 0.18 percent. Four patients (33.3%) were male and 8 patients (66.7%) were female. The mean age of the patients was 54.08±12.95 years. Nine patients were diabetic and one was hypertensive. In case of the diagnosis of the patients before surgery, 8 had diabetic vitreous, 2 had Rhegmatogenous Retinal Detachment (RRD), one had Epiretinal membrane (ERM), and one had Central retinal vein occlusion (CRVO). In case of the diagnosis of the patients after surgery, 7 had diabetic vitreous, 2 had RRD, 2 had ERM, and one had CRVO. The type of surgery was only vitrectomy in 7 cases and vitrectomy and tamponade in 5 cases. In cases with tamponade, a mixture of gas and silicone oil was used. Furthermore, seven cases underwent Avastin injection. Only one case had a coincident cataract surgery. Differences in case of comparing visual acuity, lens condition, and retinal condition were not significant before surgery, during endophthalmitis, and after surgery (p>0.05)

Conclusion: Although statistical analyses showed no difference in case of visual acuity, lens condition, and retinal condition, before surgery, during endophthalmitis, and after surgery, it seems that the low sample size is the problem. However, case by case assessment showed that visual acuity may get worse. Further studies are needed to complete the result of this study.

Purpose: To assess the possible association between Noninfectious uveitis patients serum levels of vitamin to compare it with healthy subjects.

Methods: In this case control study, 100 patients with Noninfectious Uveitis in 4 groups(Anterior Uveitis, Posterior Uveitis, Intermediate Uveitis & Pan Uveitis) and 25 normal subjects were included. Groups were compered for serum levels of vitamin D and Ca, P and ALP. Ca,P and ALP was evaluate for other disease that change serum levels of Vitamin D.

Results: 50 male (39.7%) and 76 female (60.3%) was evaluate. 94% of patients have idiopathic uveitis and 6% of patients have secondary uveitis. 83% have nongranulomatosis uveitis and 17% have granulomatosis uveitis. Mean levels of vitamin D was 21.21±11.96 in anterior uveitis, 21.81±9.65 in posterior uveitis, 21.71±13.27 in intermediate uveitis, 18.1±11.21 in pan uveitis and 23.23±18.58 in control group.
Mean levels of vitamin D were not significantly between all groups.

Conclusions: No difference between all groups in this study base on similar articles was due to high prevalence of hypovitamonosis D in normal population and small size of sampling.

Keywords: Anterior Uveitis, Posterior Uveitis, Pan Uveitis, Intermediate Uveitis, Vitamin D

Objective: Due to treatment resistant of amblyopia at older ages, in this review we aimed to evaluate the effect of Repetitive Transcranial Magnetic Stimulation ( rTMS ) on patients with all type of amblyopia in adult age.

Methods & Materials: Patients were randomly selected which were afflicted with various types of amblyopia ( anisometropic, deprivation, strabismic or mixed ) and age more than 18 years old and were resistant to conventional treatments. Their visual acuity and visual contrast sensitivity were examined. These measurements were repeated after brain stimulation with electromagnetic waves, This method was repeated again with a two-week interval for a total of four times.

Results: 16 patients, 12 men and 4 women, with an average age of 30 ± 5 years old, randomly included in this study.
Average visual acuity at first visit in amblyopic group was o.36 ±0.19 and after the first rTMS session got to 0.41±0.1 ( P= 0.71 ) . Average of visual acuity after the last session of treatment was 0.45 ±0.23 ( P= 0.04 )
Average contrast sensitivity at first visit in amblyopic group, was 2.02 cpd ± 0.74 and after the first rTMS session it was 1.97cpd ± 0.63( P= 0.91 ). Average of contrast sensitivity after the last session of treatment was 2.16 cpd ± 0.94( P= 1.00 ).

Conclusion: RTMS can be considered as a method to improve the visual acuity and contrast of patients with resistant amblyopia, but requires further investigation and studies.

Title: Comparison of Vitrectomy with Internal Limiting Membrane Peeling Using Scraper versus Pinching in the Treatment of Macular Hole

Purpose: To evaluate anatomical, vascular and visual outcomes following vitrectomy with internal limiting membrane peeling (ILMP) pinching versus abrasion using scraper in the treatment of full thickness macular hole (FTMH).

Methods: Patients with FTHM who underwent vitrectomy for FTMH were enrolled in this study. Patients were divided into two groups: in twelve cases scraper was used for ILMP (SG), in the other eight cases, by pinching, ILMP was performed (PG). Changes of preoperative to 3-month postoperative retinal thickness indices in macula and peripapillary nerve fiber layer thickness of optical coherence tomography (OCT) and vascular indices in optical coherence tomography angiography (OCTA) were compared between the groups.

Results: Twenty patients (thirteen female) with mean age of 64.5 ± 11 were included. Eight patients were categorized in scraper group (SG) and twelve patients were in the pinching group (PG). Anatomic success was achieved in all 8 patients in SG and 10 patients in PG (p=0.224).Foveal and Parafoveal thickness changes showed statistically significant changes between two groups (Mann-Whitney Test,p=0.008 in foveal thickness and p= 0.04 in para foveal thickness). Retinal nerve fiber layer changes were also not significant in both groups. Regarding macular perfusion, only changes in flow area (p=0.048) and foveal vessel density (p=0.030) showed statistically significant difference between two groups.

Conclusion: Macular hole surgery induce structural and perfusion status changes in foveal and parafoveal retinal layers. Technique of ILM peeling (scraping versus pinch) may have significant effects in this regard.

Title: Study of drug treatment with lipoic droplets in the treatment of presbyopia patients

Purpose: To evaluate the effectiveness of Lipoic acid eye drop for treatment of patients with presbyopia.

Method: In this pilot randomized, double-blind, placebo-controlled phase 2 study, a total of 30 emmetropic patients with presbyopia were assigned to receive lipoic acid eye drop (n=15) or placebo (n=15). Patients were instructed to use eye drops in each eye twice a day for 90 days. The outcome measures of the study were, uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), subjective amplitude of accommodation (both push-up and minus-lens methods) prior and 1,15,31,61 and 91 days post-administration.

Results: The mean age of patients was 47.2 ±3.2 years (range, 42-53 years). UDVA for all patients was 20/20 in each eye and remained unchanged during the follow-up periods. The mean log MAR of binocular UNVA of treatment group improved statistically significantly after 15 days of using lipoic acid eye drops in comparison with placebo (p=0.004)

There was no statistically significant difference between the two groups for both push-up and minus-lens methods (p=0.51, p=0.93 respectively). Three patients reported burning in the treatment group

Conclusion: This pilot randomized ontrolled trial of 90 days of presbyopia treatment with lipolic acid eye drop demonstrated improvement in near vision, and no reduction for distance visual acuity was observed. Additinal controlled trials with larger samples are needed to evaluate the full efficacy and side effect profile of lipolic acid eye drop for treatment of presbyopia.

Keywords: Presbyopia, Pharmcological treatment, Lipolic Acid

Objective: To compare macula, optic nerve and choroid changes in patients with ophthalmopathy thyroid and healthy individuals by OCT angiography and OCT.

Methods and Materials: A cross sectional study was conducted at Khatam Alanbia Hospital in Iran. 31 patients with Graves ophthalmopathy and 31 age and sex matched healthy individuals were studied.
Subfovea choroidal, macular, RNFL and GCC thickness measurements and three-dimensional OCTA images of macula and optic disc were performed with Optoviue. Statistical analysis of data was performed using the SPSS 16 software and significant level α = 0.05.

Results: Graves patients exhibited The fovea thickening and significant parafovea density changes in the deep part of macular OCTA. The FAZ difference between the two groups was significant (P < 0.001). There was no significant difference in the RNFL and GCC thickness between two groups.
The subfovea choroidal thickeninig was significantly in Graves patients (P < 0.001).

Conclusion: The OCT and OCTA findings suggest that the choroid and retina is involved in patients with thyroid eye disease, probably as early as the subclinical stages. Deep layers of retina and choroid changes earlier than other parts of retina.

Keywords: Graves ophthalmopathy, Optical choherence tomography, Optical choherence tomography angiography

Objective: Primary angle closure glaucoma is a heterogenous disease and there are different genetic variants which was associated with this disease. This study aimed to analyze five different polymorphisms from genome wide associated study with susceptibility of the disease in north east Iranian population.

Methods & Materials:130 primary angle closure glaucoma patients and 130 healthy controls were following up at khatam eye hospital between 2017 and 2018, were genotyped for the polymorphic regions with the aid of tetra-amplification refractory mutation system polymerase chain reaction. Association of these variants with the disease susceptibility was measured statistically with logestic regression method.

Results:130 PACG patients (53 males and 77 females) with a mean age of 64.5±6.2 years, and 130 healthy control subjects (51 males and 79 Female) with a mean age of 64.0±5.7 years were considered for evaluation. There was a significant correlation between rs3816415, rs736893, rs7494379 and, rs1258267 with primary angle closure glaucoma susceptibility. Although for rs3739821 this association was not approved.

Conclusions: It was revealed that variants in GLIS3, EPDR1, FERMT2 and CHAT genes can contribute to this disease. Additional studies in other populations needed to evaluate DPM2-FAM102A.

Purpose: To assess the possible association between keratoconus (KC) and serum levels of vitamin D, Selenium (Se), Zinc (Zn) and Copper (Cu) and to compare it with age- matched healthy subjects.

Methods: In this study, 100 patients with KC and 100 normal case-matched subjects were included. Two groups were compered for serum levels of vitamin D and three major trace elements including Se, Zn and Cu. Also, plasma level of vitamin D and these trace elements were compared between the different KC stage groups.

Results: Plasma levels of vitamin D, Zn, Cu and Se were significantly different between the KC and normal groups (p= 0.006, p=0.015, p=0.004 and p=0.038, respectively). Mean vitamin D level was not significantly different between the KC stage groups (p=0.441). Also, KC stage groups were not significantly different regarding mean Zn, Cu and Se (p=0.130, p=0.98, p=0.113, respectively).

Conclusions: Lower plasma levels of vitamin D, Cu, Zn and Se was found in the KC group compared to the control group. The results might indicate the role of antioxidant trace elements as a possible etiology of KC. Future studies are needed to verify the usefulness of vitamin D and these trace elements’ supplementation in prevention and stopping progression of KC.

Keywords: Keratoconus, Vitamin D, Copper, Zinc, Selenium. 

Objective: Comparison of optical coherence tomogeraghy angiography (OCTA) and WF FAG (wide field fluorescein angiography) and EDI OCT (Enhanced-Depth Imaging) in patients with Behcet disease (BD) with and without ocular involvement

Methods & Materials: This cross sectional, prospective, comparative study included 102 eyes from 51 consecutive patients with Behcet’s disease that had been referred to the uveitis clinic of Khatam-Al-Anbia tertiary eye center, affiliated to Mashhad University of Medical Sciences(MUMS) from October 2016 to October 2018. Complete ocular exam, including slit lamp exam and fundus examination with dilated pupil was performed for evaluation of ocular Behcet (OBD). The patients older than 18 years with definite diagnose of BD according to the diagnostic criteria of the International Study Group for BD with or without ocular involvement were recruited.EDI-OCT for measurement of sub-foveal choroidal thickness(SFCT) and WF-FAG and macular OCTA 3×3 mm was done for all of the included patients. The results of the imaging methods were then analyzed statistically.

Results: Fifty one patients (102 eyes) with inclusion criteria were enrolled in the study) 23 males and 28 females). Mean age of patients in group without ocular involvement was 38.71±7.8 years (29 to 52 years) and in group with ocular involvement was 36.22± 10.59(21-55years)(p=0.259). Mean SFCT in paitents with ocular Behcet disease (OBD) was significantly greater than patients without OBD (364.17±93.34 versus 320.43 ± 56.70; P=0.008). In patients with ocular involvement, total angiographic scoring had a significant correlation with whole superficial capillary density ( 44.582 ±6.26 and 46.730 ± 3.70 in active and inactive patients and P = 0.033) and whole deep capillary density in OCT A (46.588 ± 5.92 and 51.54 ± 4.50 in active and inactive patients, P = 0.000). The size of FAZ in OCT A had a meaningful and direct correlation with the duration of the disease in all patients (r = 0.225 and P = 0.045)

Conclusion:According to the study, the findings of this study suggest that macular OCTA and EDI OCT methods, which are non-invasive methods, may be used as auxiliary methods for the diagnosis and treatment and follow up of patients with BD.

Objective: The efficacy of nanoliposomal formulation of vancomycin after intravitreal injection against methicillin resistance Staphylococcus aureus (MRSA) induced endophtamitis in an experimental model was assessed.

Methods & Materials: Nanoliposomal formulations were prepared by solvent evaporation method and characterized for size, zeta potential and encapsulation efficacy. In vivo study was carried out on thirty eyes of 15 male rabbits (five groups) which received liquid culture medium containing MRSA under anesthesia. After 48 hours, all right and left eyes which respectively received liposomal and free form of vancomycin. The rabbits were euthanized at predesignate intervals at 12, 24, 48, 96, 144 hr intervals injection. Indirect ophthalmoscopy and vitreous sampling were obtained. The antibacterial activity of different vancomycin formulations were assayed by time killing method.

Results: The zeta potential of liposomal vancomycin was 29.7 mV, whereas the mean sizes of these liposomal formulation was 381.93 ± 30.13 nm. The encapsulation efficacy of liposomal vancomycin was approximately 47%. The results of time–killing studies indicated that the liposomal formula was more effective than free form of vancomycin at each tested time intervals.

Conclusion: The results of this study revealed that liposomal vancomyin formulation is a powerful nano-antibacterial agent to combat infectious endophthalmitis and has potential merit for further investigations.

Objective: To assess refractive errors in preterm infants following intravitreal bevacizumab injection for retinopathy of prematurty (ROP) and to compare it with untreated premature babies with spontaneous regressed ROP.Methods & Materials: Eighty seven premature infants with ROP who were admitted in ROP service of Khatam Al- Anbia eye hospital in 1396-97, were recruited in the study, according to inclusion criteria and after obtaining parental ethical consent. Based on clinical examinations, babies were divided into two groups: treatment with intravitreal bevacizumab (IVB) injection and control group. In the baseline examination, using cycloplegic retinoscopy, the status of refractive error was evaluated after regressing ROP and 6 months thereafter. Refractive changes were compared between two groups.

Results: Mean ± standard deviation of gestational age of the infants was 31.0±2.51 weeks (range: 26-36 weeks). Babies in two groups were not significantly different for gestational age and corrected age at the first examination (p<0.001 and p= 0.108 respectively). In baseline examination, mean spherical error in cases was +2.47 diopter (D) ±1.80 and +2.49 D±1.90, for right and left eyes. Mean spherical error in control group in baseline was: +2.83D±2.09 and +2.87D±1.90 for right and left eyes. Two groups were not markedly different for mean baseline spherical error (p=0.403 and p=0.366, for right and left eye respectively). Six months later, mean spherical error in cases was: +1.61D±0.77 and +1.53±0.86 for right and left eyes, and mean spherical error in control group was: +1.78 D±1.72 and +1.57 D±1.10 for right and left eyes. In 6 months follow- up, two groups were not significantly different for mean spherical error (p=0.563 and p=0.836, for right and left eye respectively). Mean spherical change was not significantly different between case and control groups (p=0.290 and p= 0.359, for right and left eye respectively). Also cases and controls did not show a significant difference in mean cylindrical changes (p=0.693 and p=0.579, for right and left eye respectively).

Conclusion: Before 1.5 years, refractive changes were not significantly different between premature infants who underwent IVB and controls with spontaneous regression of ROP. However, babies in treatment group were less hyperopic than controls.Periodic refractive examinationsare necessary for premature infants with faster changes of refractive errors into myopization.

Keywords: Premature infant, retinopathy of prematurity (ROP), intravitreal bevacizumab injestion (IVB), refractive error.

Objective: to identify the type ocular toxoplasmosis responsible for retinochoroiditis in patients coming to khatam alanbiya hospital in mashhad in 2017-2018

Methods & Materials: 24 patients who have been clinically diagnosed with active toxoplasmic retinochoroiditis at the uveitis clinic in khatam al anbiya hospital , at the same time where given the corresponding treatment and toxoplasma serology tests and PCR for the RE , B1 and GRA6 genes were performed. RE and B1 genes to confirm the presence of toxoplasma gondi and GRA6 gene to indicate it’s type. bands were separated using electrophoresis in order to identify their sequence.

Results: Out of 24 patients , 2 patients were excluded from the study because of negative serology results for toxoplasma . 12 (54.5%) patients were females 10 (45.5%) were males. The common complaint in patients was blurred vision (95.5%) and floater (54%) . out of 18 (81.84%) patients who had toxoretinitis in zone 1 , 10 patients (45.5%) due to sight threatening lesion were treated by intravitreal clindamycin + dexamethasone along with oral antibiotics and the rest of patients were only given oral azithromycin and co-trimoxazole. One patient had undergone pp.vitrectomy because of uveitis complications.
22 samples were RE positive , 20 samples were B1 positive. Out of 15 samples that were GRA6 positive 10 were sent for sequencing and toxoplasma type 3 was specified .

Conclusion: Type 3 toxoplasma has the highest prevalence in khorasan and is responsible of retinochoroiditis.

Propose: Comparison of corneal biomechanical factors before, one month and Three months after surgery in both PRK and SMILE methods using Corvis device. 
Methods & Materials: This is a longitudinal two-group study on all patient records of patients with simple refractive errorsThey were referred to ophthalmology clinic Nourafrin 1397   Patients were enrolled in this study based on inclusion criteria and after obtaining informed consent. Demographic information including age, sex and history of systemic diseases, ophthalmic diseases and history of previous ophthalmic surgeries and medications were also recorded on data collection sheet. Cases were included in the study for which both practices (PRK & Smile) were possible. The procedure was explained to the patients and one of the two methods was chosen based on the cost of the operation, the recovery time and the time required for the patients to use eye drop.Patients were followed up in each group preoperatively and one and three months postoperatively. The biomechanical parameters of Corvis, Pentacam, visual acuity and refractive error were recorded and the results were compared between the two groups.The results of two groups were compared using repeated measure anova test and Bonferroni follow-up test. 
Results: In this study, 73 patients including 23 males (30.1%) and 50 females (69.9%)Mean age in PRK group (31.06±8.57) and in SMILE group (32.31±6.72) Participated
Among the biomechanical factors studied with preoperative control, IOP, BIOP, D / A ratio, Integ.R, Velocity 1, Peak Distance, Radius, and deformation amplitude were significantly different between PRK and SMILE groups. Which were (P=.008, P=.006, P=<.001, P=<.001, P=.03, P=.002, P=.03, P=.008) Factors compared at one month and also 3 months after surgery The Iop.Biop, D / A ratio, Integ.R, peak distance, were significantly different between the two groups, respectively at the one month (p = .028, p = .02, p = <.001, p = < .001p = .003), and at the third month (p = .014, p = .006, p = <.001, p = <.001, p = .04). The radius and def amp were only compared between 1 month after surgery. Both groups were significant. (p = .045, p = .006) 
Conclusion: The results of this study showed that the biomechanical properties of cornea in the 3 month follow up after SMILE and PRK were significantly different in the corneal deformity group and improved with time in both groups. 
Keywords: corneal biomechanics, photorefractive keratectomy, SMILE

Purpose: The purpose of this study is to compare the effects of using overminus lenses versus patching in children 3 to 10 years of age with intermittent exotropia.
Materials and Methods: A randomized clinical trial was conducted on 30 patients with intermittent exotropia between 3 to 10 years of age who did not have a history of treatment and who were admitted to Khatam-ol-Anbia hospital from the beginning of April 2018 to the end of June 2019; Patients were randomly distributed into two groups for patching (20 people) and overminus lenses (10 people). In the patching group, the patient's eyes were kept close for 2 to 4 hours a day for 6 months. Overminus lenses were selected based on cycloplegic refraction between 2-4 diopters. Astigmatis was prescribed completely. The patient's follow-up was after 3 months and then 6 months. Finally, the collected data were analyzed by SPSS-20 software.
Results: The mean age of the patients was 4.531.4 years (median of 4.50 in the range of 3 to 8 years). 9 (30%) of the subjects in this study are boys and 21 (70%) are girls. The median FCR of patients before intervention of overminus lenses is 1.00 diopter for right eye and 0.75 diopter for left eye; After 6 months of intervention of overminus lenses, the median is 0.87 diopter for right eye and 0.87 diopter for left eye. The median FCR of patients before intervention of patching is 0.75 diopter for right eye and 0.75 diopter for left eye; After 6 months of intervention of overminus lenses, the median is 0.87 diopter for right eye and 0.87 diopter for left eye. As it can be observed, there is no substantial difference before intervention and after intervention in each group of overminus lenses and patching (p≤0.5). The deviation median (IXT Measurement) in patients of overminus lenses group before intervention is 25 prism for far vision, and 25 prism for near vision; After 6 months of intervention of overminus lenses, the median is 22.5 prism for far vision and 20 prism for near vision. The deviation median (IXT Measurement) in patients of patching group before intervention is 25 prism for far vision, and 25 prism for near vision; After 6 months of intervention of patching, the median is 22.5 prism for far vision and 22.5 prism for near vision. As it can be observed, there is no substantial difference before intervention and after intervention in each group of overminus lenses and patching (p≤0.5). The median of Newcastle Scale Score in patients of overminus lenses is 3.5 before intervention; The median is 1.5 after 6 months of intervention of overminus lenses. The median of Newcastle Scale Score in patients of patching is 4 before intervention; The median is 3 after 6 months of intervention of patching. As it can be observed, there is no substantial difference before intervention and after intervention in each group of overminus lenses and patching (p=0.2).
Conclusion: The results show that the two methods of overminus lenses and patching are both effective in treating patients with intermittent exotropia, but better improvement is reported for overminus lenses than patching which is not statistically significant. Of course, given the fact that the sample size is not being completed, the study will continue.

Objective: A study on the evolution of refractive errors in children with intermittent exotropia referred to Khatam-ol-Anbia Hospital in Mashhad
Methods & Materials: A study was conducted on 130 cases of patients who were referred to specialist strabismus clinics at khatamolanbia Hospital, which had been diagnosed with IXT. The target population of children under the age of 16 years was Exodative Intermittent over the past 10 years. By referring to the outpatient archives of the hospital (after obtaining a license),the records of all patients diagnosed with IXT from 1385 to 1395 ,all of the information about the state of deviation was investigated near and far deviation angles,control and fusion status and…at all examinations over time(visitation First to many) and examinations to determine their refractive errors (FCR & DRY refraction in all visits were recorded in an Excel file and a statistical comparison was used to examine the relationship between the type of defect Refraction with this kind of deviation and the amout of control and its angles took place.
Results: Most of the patients entered this project were girls and most patients had at least one type of refractive error at the time of referral , the most common hyperopia disorder at base of the study and the process of refractive changes of patients towards myopia(P< 0.05).there was no significant correlation between refractive error and fusion(P=0.87). There was also no significant correlation between the angle of deviation and fusion but at a deviation angle of 0 to 20 prisms, the difference was significant in most patients with good fusion.(p=0.003)
Conclusion: According to the results obtained , the course of changes in refractive errors in patients with intermittent exotropia over time tends to reduce the refraction of patients. Also the fusion of patients with refractive errors and deviation angles is not relevant.

Purpose:   The purpose of this study was to evaluate the predisposing factors, causes, clinical features, complications and prognosis of patients with wound dehiscence after corneal transplantation in Khatam Ophthalmology Hospital during 2007-2018.

Methods:  This study was performed on all records of patients with wound dehiscence diagnosis and history of corneal transplantation in Khatam Eye Hospital during the period of 2007-2018. Demographic information, previous medical history, inducing factor, the cause of the corneal transplantation, the time interval between corneal transplantation and wound dehiscence, the ophthalmic examinations at the time of admission, the type of treatment performed, the initial and long-term complications, gathered in the checklist for this purpose and finally summing up And analysis.

Results: This study was performed on 45 patients (31 males / 14 females) aged between 8-79 years and mean age of 37.55 ± 20.04 years. The cause of transplantation was keratoconus in 31 patients (68.9%) and corneal scar in 6 (13.3%). The type of transplantation in 29 patients (64.4%) was full thickness and lamellar in 16 (35.6%) cases. In 35 cases (77.8%) the causative factor was trauma and followed by wound dehiscence after suture removal in 10 cases(22.2%).The time interval from corneal transplantation to wound dehiscence ranged from 1 day to 28 years, with a mean of 2.99±5.24 years and a median time of 270 (32,5-1277,5) days. In the studied patients 9 cases had a history of medical disorder, of which 3 (6.7%) had history of CABG, and 5 (11.1%) had a history of diabetes and 3 (6.7%) had a history of HTN. The cause of wound dehiscence following trauma is mostly related to the handling of iron objects such as barrel punching, iron doors, tap water, the edge of the window, as well as several cases of trauma with tree branches, fists, and nails. The most common site of dehiscence in the right eye was supra temporal quadrant (42.2%) and in the left eye was infra temporal quadrant with (20%).

The final vision ranged from NLP to BCVAlog10 = -0.45. In the final exam, 66% of the subjects had the vision of CF and more and the best visual endpoint was VA 0.9 .The most commonly occurring complications in the order of prevalence were IOP rise in 10 (23.3%), glaucoma in 5 (11.6%), graft rejection in 5(11, 6%), aphakia in 3(8, 3%), vitreous hemorrhage in 2(5, 4%), iris prolapse in 1(4, 3%) of patients. The time interval of complications was from 10 days to 5 years and an average of 1.39 ± 1.73 years and median time of 365(45-912,5) days      

Conclusion: All patients who have underwent a corneal transplant are at lifelong risk of wound dehiscence. In the vast majority of our cases wound dehiscence has occurred in the first 3 years after transplantation. Trauma is the leading cause of wound dehiscence especially work related traumas and it has showed the importance of prophylaxis in the risky environment. A significant amount of cases following suture removal has revealed the importance of cautious during this procedure.   Age, sex, type of transplantation, and history of underlying illness did not play a role in final vision, Patients experienced complications such as iris prolapse, increased IOP, vitreous hemorrhage, Aphakia, glaucoma, transplant rejection, which may require more intervention.

 

Objective: to assess the effect of electronic device usage in the amount of clinical signs and the quality of vision after photorefractive cratotomy
Methods & Materials: the candidates for photorefractive surgery were asked to fill a questionnaire of demographic data, type and amount of electronic device usage with informed consent. Then they were grouped into 6 groups that underwent surgery with excimer laser Technolas 217-P (Bausch & Lomb, Germany). The patients were provided with another questionnaire after the surgery to assess the amount of pain, photophoby, and eye irritation. Furthermore, the contrast sensitivity and aulcsf were measured. The patients were classified into using electronic device less than 6 hours and more than and equal to 6 hours. Data were compared using SPSS software.
Results: 53 patients were entered in the study that 73.6 % were female and 26.4 % were male. The whole mean age was 29.62±5.77 years. About 54.7 /5 of the patients did not use any electronic device at work. The highest amount of electronic device usage belonged to mobile with 2.82±1.64 hours and television with 1.63±1.75 hours. The mean amount of the pain after and during surgery were 2.72 and 3.64. 64.2 % of the patients had eye irritation without glasses. 45.3 % of the studied cases had flare sign only in the presence of straight light in the night. Also, 50.9 % of the casesstated that had halo sight at low light environment and 20.8 % observed halo even in the normal light environment and the remainder had none of these signs. The contrast sensititvity at 3, 6, 12, and 18 spatial frequencies were 5.70±1.25, 5.82±1.79, 5.86±1.79, and 5.73±1.71. NON of the frequencies showed significant difference between the groups .
Conclusion: it is possible that the amount of suing electronic devices have a role in escalation of signs after photorefractive surgery.

Background: Diabetic retinopathy and its subsequences are of well-known complications of  diabetes. vascular injury involving choroidal vasculature  is the main etiology of diabetic retinopathy  especially in the foveal region. Optical coherence tomography is a noninvasive imaging technology through which we can see cross-sectional images of retinal and subretinal layers(involving choriocapillaris,Sattler and Haller).evaluation of choroidal vasculature layer enhances our understanding of diabetic retinopathy pathophysiology.

Methods: 58 patients with  diabetes and 30 normal individuals similar in age and sex  were involved in the study. Thickness of choroidal vascular layers were measured using optical coherence tomography system.

Results:There were no significant difference in total subfoveal choroidal thickness between diabetic patients and normal individuals. There was increased choriocapillaris layer thickness in type 2 diabetic patients with nonproliferative diabetic retinopathy without diabetic macular edema compared to controls(p=0.013). subfoveal Sattler layer thickness was reduced in type 1 diabetic patients compared to normal individuals(p=0.009).There was no significant difference in Haller layer thickness between diabetics and healthy controls.

Conclusion:Choriocapillaris was thicker in type 2 diabetic patients with nonproliferative diabetic retinopathy without DME. . diabetic choriodopathy may involve mainly the choriocapillaris therefore it is important to evaluate choriocapillaris integrity in diabetic patients.

Keywords:Optical coherence tomography,Sattler layer,Haller layer

Background: Possible Systemic absorption of bevacizumab can reduce the serum level of VEGF in infants with ROP. The aim of the study was to assess the developmental status in infants who underwent intravitreal bevacizumab injection for treatment of retinopathy of prematurity (ROP).

Method: In this cohort retrospective study, ROP cases and age-weight matched controls were followed in ROP clinic of Khatam eye hospital from Jan 2012 to December 2015.

Ophthalmology exams were performed till complete retinal vascularization. Development & growth evaluated by age& stages questionnaire (ASQ) forms were filled by parents in two sessions at the age of 6, 12 & 18 months old with pediatrician supervision. Developmental milestones in five domains (gross motor, fine motor, personal& social status, problem solving, relationship and overall issues) were assessed.

Results: 34 cases and 36 controls were included in the study. Mean birth weight and gestational age were 1,281±254 g and 29.5±2.1 weeks, respectively. In a follow-up period of 18 months, bevacizumab was effective in the treatment of severe cases of ROP as a primary treatment.

There was no significant difference between two groups regarding relationship, gross motor, fine motor, personal& social status, problem solving and overall issues in follow up intervals. (p>0.05)

Conclusion: This study does not show any systemic side effect of intravitreal bevacizumab in growth and neurodevelopmental status of infants.

Keywords: Retinopathy of prematurity (ROP), Vascular endothelial growth factor (VEGF), intravitreal bevacizumab , Ages & Stages Questionnaire(ASQ)

Introduction : Since there are numerous methods for the assessment of ocular anterior segment parameters, and each one of these methods have strengths and weaknesses, in this study we aimed to evaluate and compare these parameters with Orbscan II and Lenstar

Objectives & ( hypothesis  OR questions) : aimed to evaluate and compare these parameters with Orbscan II and Lenstar

Materials & Methods : In this study, 594 eyes from 297 refractive surgery candidates were evaluated. The anterior chamber depth (ACD), central corneal thickness (CCT), keratometry (Kr), and white-to-white (WTW) corneal diameter of candidates for keratorefractive surgery were measured by using Orbscan II, and Lenstar. Exclusion criteria were history of any intraocular and corneal surgery, contact lens wear and corneal anomalies. The differences between the reported values were compared by the Student paired t-test using SPSS 22.

Results : The mean CCT measured by Lenstar was smaller than that measured by Orbsacn II (p <0.001). The mean WTW was smaller with Orbscn than Lenstar (p <0.001). The mean ACD was also lower with Lenstar than with Orbscan II (p <0.001). Orbscan II provided significantly (p < 0.0001) different measurements for ACD, CCT, WTW corneal diameter, Kr _{Max, Min}, and Kr _Diff compared to Lenstar.

Conclusion : The measurement of ACD, CCT, WTW corneal diameter, minimum and maximum keratometry (Kr _{Max, Min}), and difference in keratometry (Kr _Diff) by Orbscan II, and Lenstar provided different results, indicating that these systems are not interchangeable. . Moreover, the regression analysis, which was performed to measure the relationship between the reported values for the studied parameters, demonstrated a good linear relationship between the values of all parameters measured by the two methods.

Introduction: Cataract is the most common cause of blindness worldwide. The surgery is the main proper treatment for cataract-related visual loss. Presently Phacoemulsification is the gold standard way of cataract surgery. The used Ultrasonic energy in Phacoemulsification can carry the risk of ocular tissue damage, especially in cataracts with hard nuclei. To reduce the iatrogenic effects of ultrasound on eye tissues and to increase efficacy of surgery different Phaco modes had been used including pulse, burst and continuous mode. The aims of this study were to compare the effects of different frequencies of phacoemulsification with pulse mode on lenses with moderate and severe nuclear hardness and to evaluate post-operative outcomes.
Method: All the patients with moderate and severe cataract up to 127 who referred to Khatam-al-Anbia eye clinics with any of two types of lens hardness were recruited for the study. Eleven patients failed to fulfill inclusion criteria and seven patients were excluded according to exclusion criteria. One hundred and twenty seven patients (69 with moderate and 58 with severe nuclear hardness) were randomly assigned to one of the frequencies of 10 and 60 PPS (63 with frequency 10 and 64 with frequency 60). The five variables of best corrected visual acuity, endothelial cell count, corneal edema, central corneal thickness and effective phaco time were evaluated in this study.
Results: The results of this study showed that lens hardness had statistically significant effect on best corrected visual acuity; better in nuclei with moderate hardness. Endothelial cell loss and effective phaco time both were less when operating on nuclei with moderate hardness. The used frequency had statistically significant effect on best corrected visual acuity; better with frequency 10. Corneal edema and effective phaco time bothless when frequency 10 was applied. The Central Corneal Thickness was only correlated with time and increased as the time passed from surgery.
Conclusion: We concluded that the surgery outcome in regard to endothelial cell loss, improvement in visual acuity, and effective phaco time during surgery was better for patients with moderate nuclear hardness. Using Phaco with frequency 10 was accompanied with better outcome considering visual acuity improvement, degree of corneal edema after surgery and less effective phaco time during surgery.
Keywords: cataract, nuclear hardness, phacoemulsification, pulse, ultrasound

Introduction: Amblyopia , the commonest childhood vision disorder, is typically diagnosed by  significantly reduced visual acuity without detectable structural or pathologic causes. deficiencies  other than visual acuity such as  loss of contrast sensitivity has been demonstrated. A comparison between the normal eyes and the corresponding amblyopic eyes have been shown deficieny of  the contrast sensitivity functions in the amblyopic eyes.

Objectives & ( hypothesis  OR questions): determine the effect of patching  of the better eye on visual acuity (VA) and contrast sensitivity function in patients with mild to moderate amblyopia.

Materials & Methods: This prospective study enrolled 25 mild to moderate unilateral   amblyopic subjects aged 5-18 years with BCVA 20/100 or better in the amblyopic eyes Complete ophthalmic evaluation was done. The Best Corrected VA (BCVA) was measured based on LogMar scale. contarst sensitivity was evaluated with the Vector Vision CSV-1000E.patients regarding age and the severity of amblyopia, underwent daily patching. After that, in follow-up visits at 1, 3 and 6 months, VA and CSF were again evaluated .  The data were analyzed with the SPSS software version 23 . P values of .05 or less were considered as statistically significant.

Results: A total number of 25 patients with the mean age of 7/16 years were recruited in this study. CSF variable was measured at 4 various frequencies at every follow-up time. The CSF was significantly lower in amblyopic eyes in comparison with fellow eyes in all frequencies(p<0.001).  The patching significantly improved  CSF in middle frequencies( B and C), had  nearly significant effect  on improving grade A (p=0.051),  but was not effective in  improving D . Age of start of patching had no significant effect on final CSf. The visual acuity increased to significant level(p=0.023).we did not find reverse amblyopia in the fellow eye after completion of study.

 Conclusion : Contrast sensitivity (CS) testing has become an important clinical tool in the battery of tests used to characterize patients’ vision. It is recommended that intermediate frequencies of CSF  test to be applied as a side and complementary test to treat amblyopia.

 Keywords : amblyopia, contrast  sensitivity, visual acuity, patch therapy

Background: Tear film plays an essential role in maintaining ocular surface epithelium health. It prevents desiccation. Tear film contain nourishing and antibacterial factors such as epidermal growth factor (EGF), fibronectin, vitamin A and neurotrophic growth factor. These factors are necessary for ocular surface epithelium hemostasis, and their lack induce ocular surface damage and lead to persistent epithelial defects. Fox for the first time in 1934 mentioned benefits of using autologous serum in dry eye in Sjogren’s syndrome. After that, ASED (Autologous Serum Eye Drop) has been widely used in treating ocular surface disorders.  ASED acts as a lubricant and also has lots of necessary growth factors (like; vitamin A, EGF, fibronectin and so many cytokines) to heal the damaged epithelium.

PRP (Platelet-Rich Plasma) contains more platelet than plasma. It acquired by centrifuging whole blood added to anticoagulant. Platelets are necessary in wound healing. They come to the wound area and attach to damaged tissue quickly. So that a lot of growth factors and cytokines release leads to liberating PDGF, platelet factor IV and TGF-β from α granules of platelets. Because PRP having high amount of growth factors it may promote effective wound healing.

Method: We analyzed 35 eyes from patients at the Khatam hospital of Mashhad between May2012 and September 2014. 19 eyes have been treated by PRP (Platelet Rich Plasma) and the other 16 eyes were treated by ASED 20 %( Autologous Serum Eye Drop). The treatment has been used in patients with chronic ulcer that did not respond to any other conventional therapy. Informed consent for the treatment was obtained from all patients after the possible complications were explained to them. The assessment results contain BCVA, symptoms and slit lamp examinations of the first week and first month of therapy recorded in their check lists. We also took some photos of defect healing process during follow up. Patients’ epithelial disorders divided into three groups; persistent epithelial defect (PED), punctate epithelial erosion (PEE) and filamentary keratitis (FK).

Results15 eyes experienced complete healing with no other defect, 16 eyes had partial healing and in 2 other treatment failed. In PRP-treated group 9 patient had complete healing, 6 ones had partial healing and treatment failed in two patients. In ASED group 6 patients healed completely and 10 patients had partial healing.in PRP group 2 patient did not complete the therapy.

Conclusion: Autologous Serum and Platelet-Rich Plasma both can be effective in corneal epithelial wound healing. This study showed no significant difference between these two in healing corneal epithelium.

Keywords: Platelet Rich Plasma, Autologous Serum Eye Drop, Persistent Epithelial defect, Neurotrophic keratopathy, Filamentary Keratitis, Diffuse Punctate Epithelial Erosion.

INTRODUCTION: Endophthalmitis following intravitreal injection is an intraocular infection due to bacteria or fungi involving the vitreous and / or aqueous. This infection is a rare but dreaded complication and without appropriate treatment causes permanent visual loss. The purpose of this study is to report prevalence and visual outcome in acute endophthalmitis after intravitreal injection.

METHODS:  This single center retrospective non comparative case series study included all patients who underwent intravitreal injection and developed acute endophthalmitis  in Khatam – Al - Anbia eye hospital affiliated to Mashhad University of Medical Sciences from march 2005 to march 2015.  Demographic data and ocular findings of 12 patients with endophthalmitis were reviewed. We converted patients visual acuity to LogMAR for comparation. Recorded data analyzed using SPSS software version 20.

RESULTS: There was 12 cases of acute endophthalmitis  among a total of 23618 injections. The incidence of acute endophthalmitis  was 0.053% ( 1 per 1883 injections). Bevacizumab was the most common drug used (66.7%). Other drugs were triamcinolone (3.4%), Bevacizumab+ triamcinolone (3.4%) and Bevacizumab+ dexamethasone(16.7%). The median age was 61.83 years( range, 51-75 years. The median number of days from injection to presentation was 1.82(1-9) days. The most common symptom was pain(58.3%). Three cases out of 12(25%) were culture-positive.Two cases caused by Staphylococcus epidermidis and other case by  Staphylococcus aureous. The initial treatment in all patients  was intravitreal injection of antibiotics. Vitrectomy was performed  in 4 (33.3%) cases. Comparation between primary visual acuity and final visual acuity was significant ( p = 0.011) but was'nt significant after treatment.(P=0.686)

CONCLUSIONS: The rate of endophthalmitis was very low ( 0.053% ) but visual devasting. Acute endophthalmitis is a medical emergency. The use of intravitreal injection has greatly increased, therefore prevention, immediately diagnosis and treatment are important.

KEYWORDS : endophthalmitis,  intravitreal injection, Bevacizumab

Background: Retinopathy of prematurity is a complex disease initiated by abnormal retinal vascularization in premature infants. ROP causes more than 10% of childhood blindness in developed countries. On the other hand ROP is a preventable disease with determining its risk factors and make them least. Incidence rate and risk factors of ROP varies everywhere in the world. Then it's necessary to determine incidence rate and risk factors of ROP in our area.

Method: In a retrospective study, data for premature infants who referred to ROP clinic of Khatam Al-anbia eye hospital (2010-2013) were recorded and analysed using T-test and chi-square test. Patients who have inclusion criteria and have not exclusion criteria were chosen. All patients were examined with fundus photography retcam and indirect ophthalmoscopy.

Results: Among 898 premature infants who referred to Khatam Al-anbia hospital, there were 597 (67.0%) different stages of ROP. Data analysis showed a significant relationship between low birth weight, prematurity, NICU admission, oxygen therapy duration, IVF fertilization, surfactant administration and ROP (P < 0.005). While gender, other systemic disease and type of delivery are irrelevant variables to ROP (P > 0.005).

Conclusion: there is a relatively high incidence of ROP in these area which needs more investigations. low birth weight, prematurity, NICU admission, oxygen therapy duration, IVF fertilization, surfactant administration therapy were independent ROP determinants.

Keywords: Retinopathy of prematurity, Screening, Risk factor

Background: uveitis encompasses a large group of inflammatory diseases. The prevalence varies according to geographic regions, age, gender and systemic factors (For example Behcet's disease is more common in the East and Mediterranean region).This study addresses the associated systemic diseases in uveitis patients.

Methods: in this cross-sectional study 235 patients with uveitis who had been referred to the uveitis clinic in Khatam-Al-Anbia eye Hospital affiliated to Mashhad University of Medical Sciences, classified and analyzed with  respect to age, gender, anatomical location, etiologic and clinical features and  treatment modalities.

Result: At the onest of uveitis, the mean patient age was 35.73 year, and female to male ratio was 1.5/1. In this study the most common anatomic was pan-uveitis (48.9%) followed by anterior uveitis (34.0%), intermediate uveitis (12.8%) and posterior uveitis (4.3%) in descending order. According to this study, both eyes had been involved in 150 cases(63.8%), and in 85 cases(36.2%), patients had unilateral involvement. the left eye was more affected than right eye. 28.5% of patients had no identified etiologies. The most common associated systemic disease were Behcet disease, Vogt-Koyanagi-Harada (VKH), and tuberculosis respectively.

The most common etiology was idiopathic and then Behcet in anterior uveitis, idiopathic in intermediate, toxoplasmosis and serpiginous in posterior uveitis, Behcet and VKH in panuveitis. Overall noninfectios cases (81.7%) were more frequent etiology of uveitis as compaired to infectios cases (18.3%). Noninfectious uveitis was 85% in anterior uveitis, 79.13 % in panuveitis, 90% in intermediate uveitis, 60% in posterior uveitis. In final treatment Prednisolone, Methotrexate, Azathioprine were more used than primary treatment, because they are more safe  than other drugs,  have less cost and less systemic complications.

Conclusion: Uveitis clinical pattern is different according to geographic location and study center . The most common associated diseases were Behcet's disease, VKH, herpes simplex, FHI.

Key words: Epidemiology, Etiology, Systemic disease, Uveitis.

Background: Retinopathy of prematurity ( ROP) is a disorder of  the developing retina of low birth weight preterm infants that potentially leads to blindness in a small but significant percentage of those infants. Recently there has been interest in off-label use of anti vascular endothelial growth factor agents for ROP. This study aims to evaluate the efficacy of intravitreal bevacizumab monotherapy in retinopathy of prematurity.

Method: the single center retrospective , non comparative case series study included all infants who consecutively underwent intravitreal injection of bevacizumab as monotherapy for stage 3 (plus) of ROP in Khatam-al-Anbia Eye Hospital at Mashhad University of Medical Science. Medical records of 89 infants from October 2011 throughout March 2015 were reviewed. We recorded demographic data and ocular findings at the beginning and follow up visits. Recorded data were analyzed using SPSS software version 20.

Results: This study includes 157 eyes of 89 infants and 168 injection of which 86 (51.2%) had zone 1 disease and 82 (48.8%) had zone 2 disease. 11 eyes (7%) received second injection. Mean Birth weight and gestational age were 1154±265 gr and 28.6±1.5 w respectively. Mean time of Plus disease resolution and start of vascularization was 17.6±22.5 and 44.4±44.4 day after injection respectively. Mean post menstrual age of last follow up was 66.7±14.2 w. No patient showed ocular or short term systemic side effects.

Conclusion: Bevacizumab monotherapy is an effective and safe treatment modality in patients with stage 3 retinopathy of prematurity.

Keywords: bevacizumab, retinopathy of prematurity, efficacy

 Supervisors:

Introduction:Strabismus is a common ocular problem in which genetic factors may have a role in development and in some familial cases many causative mutations have been proposed for this ocular disease. Among suggestive genes for strabismus AHI1, NEB and PAX3 are listed as the culprit genes. The causative mutations in these genes have been reported to be related to strabismus in some populations. In the present study, genetic mutations in these 3 genes have been firstly screened and then using whole exome sequencing (WES) in search for possible causative mutations has been done.
Materials and methods: Four families with history of multiple cases of primary and non-syndromic comitant strabismus including esotropia or exotropia, or both were enrolled in this study. Polymerase chain reaction (PCR) and Sanger sequencing of exon 23, 11 and 3 of AHI1, NEB and PAX3 genes were performed. One offspring of a consanguineous marriage underwent WES and the suggestive variants were studied in individuals with strabismus and 100 healthy unrelated control subject.Results: Sanger sequencing of exon 23, 11 and 3 of AHI1, NEB and PAX3 genes did not reveal any causative mutations. The WES study demonstrated 2 possible variants in MYO5B and DHODH genes. Although these genetic variants were reported as damaging in current databases, however, in our population, these two variants showed higher allele frequency than expected.
Conclusion: Pathogenic status of MYO5B and DHODH variants cannot be confirmed in our population. AHI1, NEB and PAX3 genes also seem to have no effect on the disease.
Keywords: Strabismus, genotype, Whole exome sequencing

 Supervisors:

Introduction:To evaluate treatment outcomes and angle parameter changes after Trabectome combined with phacoemulsificatin cataract surgery in a series of 19 eyes with open-angle glaucoma in a 6month follow up.
Methods & Materials: 19 consecutive eyes that have had combined phacoemulsification with Trabectome were included. The main outcome measures were change in intraocular pressure (IOP) and number of glaucoma medication use. All patients were assessed with AS-OCT before & after intervention. Before & after trabectome angle parameters compared for any difference.Trabectome cleft width and its ablation arcade measured by AS-OCT and analyzed for any correlation between intraocular pressure reduction and trabectome ablation cleft.Results: Mean IOP was 14.7±4.4 mmHg preoperatively which decreased by 16.5% to 11.53±2.1mmHg at 6month postoperatively(P=0.004).There was a corresponding 85.2% drop in glaucoma medications from 2.53±1.12 at baseline to 0.43±0.83 at 6 months (P <0.001).complete success rate of 73.6% and qualified success rate of 26.4% achieved at 6month.Mean trabectome cleft width was 0.492±0.016mm at 1month postoperatively which reduced significantly to 0.466±0.017mm at 6month follow up(P<0.001).Mean trabectome ablation arcade decreased significantly from70.4±5 degree 1month postoperative to 66.8±4.9 degree at 6month end time.(P=0.004).No correlation proved between trabectome ablation arcade and cleft width with percentage of IOP reduction.
Conclusion: Combined phacoemulsification and Trabectome significantly lowered IOP and medication use in POAG patients.Trabectome is a microinvasive glaucoma surgery with a good safety profile and IOP lowering effect and could be considered as an optimal method for properly selected patients. AS_OCT is a good diagnostic modality optimizing angle visualization and should be efficiently used to manage glaucoma.

 Supervisors:

Objective: Photorefractive keratectomy (PRK) and LASIK (laser-assisted in situ keratomileusis) are two famous laser-based eye surgeries used for correction of refractive errors. During these procedures the corneal stroma is laser ablated for the desired effect. Refractive power of eye changes gradually after PRK and LASIK until it reaches a plateau and epithelial wound healing has a vital role in predicting the final refractive power of eye. Considering the complex and important role of epithelium in refraction, further understanding of epithelial thickness changes after refraction surgeries can help us improve the surgery results and lower the complications. In this study we aimed to assess the epithelial thickness changes before and after PRK or LASIK in a wider diameter of 9 mm compared to previous studies. Moreover we sought to describe the pattern of these changes and elicit their relation to spherical equivalent after surgery.

Methods & Materials: Refractive power and epithelial map of central 9 mm of cornea was measured using Anterior segment optical coherent tomography (AS-OCT) in 134 myopic eyes before undergoing PRK or LASIK. Patients were categorized into three groups, PRK 1 group consisting of patients undergoing PRK with target Spherical Equivalent (SE) of more than -4, PRK 2 group consisting of patients undergoing PRK with target SE of less than -4 and LASIK group consisting of patients undergoing LASIK. Then patients were examined one, three and six months after surgery and their refractive power and epithelial map was assessed. Collected data were analyzed using appropriate statistical tests by SPSS version 22.

Results: This study included 134 eyes of 67 patients. Post-op SE was significantly lower in LASIK group compared to PRK 1 and PRK 2 groups. Pre-op corneal epithelial thickness was not statistically different among the three groups, however the epithelial thickness became significantly higher in LASIK group one month and three months after the surgery. In all three groups and in different time intervals the epithelial thickness decreased when going from the center of the cornea to more peripheral parts. Although this pattern was more significant in PRK groups. Our assessment of the correlation between epithelial thickness changes and SE changes showed that epithelial thickness changes are conversely correlated with SE changes in PRK 1 group, during the first to three months after surgery in the paracentral zone and during the third to sixth months after surgery in the mid-peripheral zone. No such correlation was found in other groups or other zones and time intervals.

Conclusion: Refractive regression is a major problem with laser assisted refractive surgery. The reason for this phenomenon is not clearly understood yet. However epithelial and stromal change and remodeling after surgery plays an important role in refractive regression. Our  results and similar studies showed that the pattern of epithelial changes after PRK or LASIK follows a lenticular pattern. Moreover we showed that epithelial thickness changes in the paracentral and midperipheral zones of the cornea after PRK is correlated with changes in SE whereas no such correlation was found in any other studies. The relationship between refractive changes and epithelial thickening after PRK or LASIK need further studying for it to be fully defined, however knowledge of this relationship can be used to improve patient selection and better prediction of the final results of PRK.

Keywords: PRK, LASIK, Corneal Epithelium, AS-OCT, Pachymetry  

 Supervisors:

Objective: Frequency of sinonasal problems in patients with acquired nasolacrimal duct obstruction

Results: 44 patients were conducted in this study.averege age 42(SD=12) and  range(20-67 years old).there were 36 female (70.4%)and 11 male(29.5%).of these patient ,32persons (72.7%)had some sinonasal problems.36 persons (81%)had unilateral NLDO and 8 persons (18%)had bilateral NLDO.

Of the 36 persons had unilateral NLDO 28 persons(77%)had sinonasal problems and septal deviation was the most sinonasal problem.in 8 patient with bilateral NLDO 62.5% had nasal septal deviation in the same direction as the lacrimal obstruction, and in 1 person, 12.5% of theseptal  deviation was opposite to the lacrimal duct obstruction.
Conclusion: highfrequency of  sinonasal problems were found in acquired NLDO so preoperative sinonasal examination is suggested in these patients.

 Supervisors:

Objective: To Compare the effectiveness of systemic pain reliefs on postoperative pain and symptoms of corneal collagen crosslinking.

Methods & Materials: In this randomized clinical trial and easy non-probability sampling method, various pain relief and anti-inflamtory systemic drugs including diclofenac 100mg tablet, pregabalin 75mg tablet and gabapentin 300mg capsule, with anti-inflammatory and analgesic effects were used to manage the patient after CXL and the effects of These regimens were evaluated using a standardized Visual Analogue Scale and Wong-Baker faces pain rating scale, individual function, redness, conjunctival inactivation, eyelid edema and photophobia.

Results: There were forty patients in this study. According to the explained protocol, patients were divided into four groups of ten. Eghiteen patients were female and twenty-two patients were male. Overall, the results showed that in the two groups who took Gabapentin and Pregabalin compared to the control groups and the Diclofenac group, better control of pain, edema was better controlled in gabapentin and pregabalin users and generally used Postoperative systemic analgesic drugs especially gabapentin and pregabalin significantly reduces the incidence of injenction of conjunctiva. Systemic analgesics and anti-inflammatory drugs also did not affect photophobic control. Also In patients taking gabapentin and pregabalin, the daily function limitations improved faster.

Conclusion: The results of the study showed that systemic analgesic drugs is effective in reducing the pain and orher discomforts of postoperative CXL. According to the results, gabapentin and pregabalin seems to be more effective than diclofenac, and we recommend using them to control postoperative pain and other discomforts.

 Supervisors:

surgery to correct eye refractive errors has increased. Usually, steroids are commonly used to relieve postoperative pain. Regarding the therapeutic regimens and the various treatments available and the differences in the results of different post-PRK pain control methods, it is necessary to determine a specific treatment protocol. In this randomized clinical trial and easy non-probability sampling method, various systemic drugs with anti-inflammatory and analgesic effects were used to manage the patient after PRK and the effects These regimens were evaluated using a standardized Visual Analogue Scale, individual function, redness, conjunctival inactivation, eyelid edema and photophobia. Overall, the results showed that in the two groups who took Pregabalin and Gabapentin compared to the control groups and the Diclofenac group, better control of pain, edema was better controlled in gabapentin users and generally used Postoperative systemic analgesia significantly reduces the incidence of conjunctiva. Systemic analgesics and anti-inflammatory drugs also did not affect photophobic control.

 Supervisors:

Objective: To evaluate the refractive and visual outcomes of photorefractive keratectomy (PRK) with the use of adjunctive mitomycin C (MMC) 0.02% for patients who have previously undergone LASIK but are left with some regressed or residual refraction.

Methods & Materials: This prospective interventional study included 60 regressed or residual myopic eyes treated by PRK on the corneal flap, after having a LASIK procedure done during 2015-2017. In this study, PRK was performed by 0.02% MMC solution was applied twice for 60 secs, bandage contact lenses were then used for 1 month after PRK. Patients were prescribed with antibiotic drops, corticosteroids and artificial tears after the procedure. Visual acuity, refraction and keratometry were analyzed preoperatively and at 1, 3, 6 and 12 months after operation and aberrometry, contrast sensitivity test and corneal haziness grading were done before and 12months after PRK then data were analyzed by SPSS V.16.  

Results: There were no complications during or after the second surgery. This study was done in 30 patients that included 16 female (53.3%) and 14 male (46.7%). The patient's age rang was 27 to 50 years old the mean age was 35.77±5.244. The mean time between PRK and previous surgery was 8.14 (range: 2-14 years). The mean spherical equivalent (SE) was -2.34±1.217 preoperatively changed to -0.21±0.218 (p=0.001<) and mean Uncorrected Visual Acuity (UCVA) 0.64±0.265 improved to 0.005 log MAR(p=0.001<). Contrast sensitivity increased following the refractive PRK. Mean total HOA RMS increased from 0.36± 0.03 to 0.37± 0.03 µm (p=0.006) at 1 year. 61.7 % of the patients did not experience corneal opacity after the operation. However, 38.3% experienced it with a grade of 1. Safety index and efficacy index were 0.66.

Conclusion: PRK with MMC and extended wear of contact lenses is an effective method for the treatment of myopia, occurring after LASIK procedures. This type of procedure prevents corneal ectasia and other flap related complications.

 Supervisors:

Objective: to assess post vitrectomy changes of subfoveal choroidal thickness in diabetic patients with tractional clinically significant macular edema (CSME), in order to investigate the possible post- operative structural changes of this layer in this group of patients.
Methods & Materials: Thirty-one diabetic patients with a diagnosis of tractional CSME who were referred to retinal clinic of Khatam-Al-Anbia eye hospital in Mashhad between years 1395 and 1396, after getting an ethical consent and considering inclusion and exclusion criteria were enrolled the study. Vitrectomy or concurrent operation of vitrectomy and cataract was prformed for participants. Macular and sub-foveal choroidal thickness were evaluated pre-operatively and at intervals of 1, 3 and 6 months post-operatively using EDI-OCT. The results were analyzed by SPSS software and compared with the other eyes of the patients.
Results: The mean ± standard deviation of the age of the patients was 29.28 ± 13.1 years. The mean ± SD of pre-operative visual acuity in operated eyes (0.170.14) was not significantly different with the 6 months after surgery (0.13 ± 0.17) (p = 0.076). The mean choroidal thickness in the operated eyes decreased from 314.71 ± 59.29 μm before surgery to 288.63 ± 59.68 μm 6 months after surgery (p = 0.009). Also, in the operated eyes, mean macular thickness decresead significantly from 557.74 ± 149.53 μm before surgery to 394.88 ± 124.99 μm, 6 months post- operatively (p <0.001) . Pre- operatively and 6 months post- operatively, visual acuity in both eyes was significantly different (p = 0.001 and p = 0.04, respectively). Six months post- vitrectomy, interventional and non interventional eyes were not significantly different for the mean of choroidal and macular thicknesses (p = 0.92 and p = 0.28, respectively). The reduction of subfoveal and macular thicknesses in the follow up of 1 month, 3 months and 6 months after surgery was significant. (P = 0.02 and p <0.001 respectively). In 6 months post- operative follow up, there was no correlation between the type of surgical technique and thickness change of sub-foveal choroid and macula (p = 0.61, p = 0.37, respectively).
Conclusion: Vitrectomy surgery in patients with CSME is associated with decreasing sub- foveal choroidal thickness and macular thickness in to the normal level. Viterectomy in these patients improves retinal and choroidal layers anatomically, while significant visual improvement may not be observed.

 Supervisors:

Objective: To assess the visual, refractive, topographic, tomographic and biomechanical outcomes of implantation of intrastromal corneal ring segments (ICRS) in keratoconic eyes according to coincidence of topographic and comatic axes.

Methods & Materials: Fifty-six keratoconic eyes of 56 patients with history of Ferrara-type ICRS implantation were included; Thirty-three eyes without coincident and twenty-three eyes with coincident topographic and comatic. Refraction, uncorrected distance visual acuity (UDVA), Best corrected distance visual acuity (BCDVA), Topography, Pentacam, ORA and Corvis parameters analyzed before and 12 months after the ICRS implantation.

Results: Postoperative UCVA, BCDVA, sphere and cylinder improved significantly (P value < 0.05) and Ks, MinK and MeanK decreased. No significant changes in ORA and Corvis parameter were observed. Visual, refractive, topographic, tomographic and biomechanical properties didn’t show any significant difference between coincident and no coindicent groups.

Conclusion: Coincidence of comatic and topographic axis doesn’t change visual, refractive, topographic and biomechanical properties significantly in ICRS implanted eyes using manufacturer nomograms. Corvis biomechanical parameters shows no significant difference after ICRS implantation in keratoconic eyes.

 Supervisors:

Objective: Acute dacryocystitis is a complication of lacrimal duct obstruction at the nasolacrimal duct.  Evaluation of the status of the tear outlet system in terms of complete duct obstruction or partial obstruction by using irrigation test helps to better understand the pathogenesis of lacrimal sac infection and appropriate therapies.

Methods & Materials: 44 patients with acute and subacute dacryocystitis referring to Khatam-ol-Anbia Hospital in Mashhad during a one-year period (mid-1395 to mid-96) were studied.  Of the 44 patients, we succeeded in cultivating 30 people.  The cultures were obtained from discharges through regurtitaion of lacrimal sac and if there was abscess, from the abscess and lower nasal mucus.  After relative improvement (one week of antibiotic treatment), irrigation test was performed during follow up and patients were divided into complete and partial obstruction groups.

Results: The average age of participants was 43 years with a standard deviation of 12.  The prevalence of dacryocystitis in women was more than 30 (68.2%) versus 14 (31.8%).  Of the 44 patients studied, 33 (75%) had acute dacryocystitis and 11 (25%) had subacute dacryocystitis.  Of the 44 patients, 23 patients (52.3%) were diagnosed with complete nasolacrimal duct obstruction and 21 (47.7%) had partial obstruction.  Of 33 patients with acute dacryocystitis, 18 (54.5%) had partial lacrimal duct obstruction and 15 (45.5%) had complete obstruction.  Four cultures (13.3%) were contaminated from 30 patients who were examined with nasal meatus and nasal sac. In 16 cases (53.3%), the culture of the lower nasal meatuses and the lacrimal sac was similar and in 10 cases (33.3%)  The culture of the lower nasal meatuses and the lacrimal bag differed.  Of the pathogens obtained from the lower nasal meatus, 8 cases (30.8%) of pseudomonas and 7 cases (26.9%) of Staphylococcus aureus and 4 cases (15.4%) of Staphylococcus epidermidis were the most common.  Of the pathogens obtained from the lacrimal sac, 8 cases (30.8%) of Staphylococcus aureus and 6 cases (23.1%) of Pseudomonas and 4 cases (15.4%) of Staphylococcus epidermidis were the most common.

Conclusion: According to this study, the incidence of acute lacrimal sac infection in patients with dacryocystitis does not necessarily mean complete obstruction of the lacrimal duct and the need for dacryocystorhinostomy (DCR), and about half of the cases are partial nasolacrimal duct obstruction.  Considering the similarity of the pathogens of acute lacrimal sac infection with the lower nasal meatus in about half of the patients in this study, it can be assumed that the relative obstruction of the nasolacrimal duct is with a higher chance of acute lacrimal sac infection due to the transfer of microbes from the nose to the lacrimal sac.

 Supervisors:

Objective: To assess the effect of intravitreal injection of bevacizumab on refractive and biometric parameters of the eye.

Methods & Materials: Twenty- seven participants, aged between 35-50 years who were candidates for intravitreal injection of bevacizumab were evaluated for dry and cycloplegic refraction, amplitude of accommodation (measured by Ruler and also negative lens), keratometry, axial length, anterior chamber depth, lens thickness, vitreous length (using Lenstar optical biometry) and central corneal thickness (by ultrasound biometry), before, 1 month and 3 months after injection. The results were compared and the changes were obtained. 
Results: The mean ± standard deviation of the age of the participants was 45.18 ± 2.68 years. The mean best corrected visual acuity of patients after injection increased significantly (p = 0.002).  Repeated measures ANOVA test and its nonparametric equivalent, showed that there was no significant difference between the refractive parameters of the eyes of patients before and after injection (p> 0.05 for all measured parameters). Also, there was no significant difference between the mean of amplitude of accommodation of participants before and 1 and 3 months after injection (p = 0.089). Also, biometric parameters were not significantly changed when compared before and 1 and 3 months after injection (p> 0.05 for all parameters).

Conclusion: Intravitreal injection of bevacizumab in short term post- injection follow-up, has no significant effect on ocular refractive and biometric parameters and amplitude of accommodation.

Supervisors:
Dr. Siamak Zarei-Ghanavati
Dr. Alireza Eslampour

Methods and Materials: This cross-sectional study includes 59 Ophthalmology residents of Khatamol Anbiya Hospital of Medical University in Mashhad. Before surgery, blood pressure and base pulse of assistant were measured and recorded. During phacoemulsification surgery performed at specific intervals, the measurement of blood pressure, pulse rate and oxygen saturation of arterial blood was done by monitoring device and recorded in the specific questionnaire. The inclusion and exclusion criteria were: all Ophthalmology residents who can perform cataract surgery using phacoemulsification method. The exclusion criteria were: use of antihypertensive drugs or any drug that puts on vital signs as well as catching any disease that affects the blood pressure and pulse.
Findings: The results showed that the oxygen level of people during different stages of surgery has no significant difference with gender, education years of residents, type of surgery, and type of anesthesia, use or non-use of sedation drug. The assessment of blood pressure showed that the diastolic pressure trend of second year residents is significantly higher than third and fourth year residents and the diastolic pressure of third and fourth year residents is significantly higher than fellowship students. The trend of heart rate changes during surgery has no significant difference with gender, the education year of residents, type of surgery, type of anesthesia and use or non-use of sedation. The perceived stress level of women was significantly higher than men (P=0.036). The second year residents significantly have more stress than last year residents and the last year residents significantly have more stress than fellowship students. Inderal medication use was significantly associated with reduced stress.
Conclusion: Finally, this study showed that heart rate and systolic blood pressure increase during surgery. Also, the surgeon's experience affects the stress of surgery. The genders, complexity of surgery, type of anesthesia and sedative drugs have no role on vital signs. The stress was significantly higher in females. Also, with increasing experience, students felt less stress during surgery.

Supervisors:
Dr. Hamid Gharaee

 By:

Objective: To assess the effect of pre-operative prednisolone acetate 1% on intra-operative mydriasis and post- operative pain, in uncomplicated cataract surgery in diabetic patients and to compare it with non- diabetic patients.

Design: Randomized clinical trial

Materials and methods: Eighty patients were enrolled in the study and were scheduled for cataract surgery. Patients were diabetic and non- diabetic patients who were randomly divided in to intervention and control groups. Interventional groups received prednisolone acetate 1%, and control group received artificial tear 4 times 1 day before surgery. Pupil diameter was measured using caliper at the beginning and at the end of the study and the amount of mydriasis maintenance was compared between groups.  VAS pain scale questionnaire was completed for all patients to compare post- operative pain between groups.

Results: Mean± SD of post-operative pupil diameter was significantly different between groups. (p=0.039) The mean intraoperative myosis was not significantly different between groups (p=0.409) but it was higher in placebo groups, especially in diabetic patients. Non- diabetic interventional group showed not significantly different but more intraoperative maintenance of mydriasis than patients in other groups. Postoperative photophobia in non-diabetic patients who received prednisolone drops was significantly lower than in their placebo group. (P <0.001). Also, post- operative itching was significantly lower in diabetic and non- diabetic patients who received pre-operative prednisolone. (P = 0.006 and p = 0.024, respectively). The amount of pain reduction was significantly higher in non- diabetic interventional group. (p= 0.045) 

Conclusion: Topical prednisolone acetate 1%, can be used as a preoperative auxiliary drug to maintain intraoperative dilatation of the pupil in diabetic and non-diabetic patients

Keywords: Cataract, Mydriasis, Inflammation, Diabetes

Supervisors:
Dr. Naser Shoeibi

Advisers:
Dr. Saeed Shokoohi-Rad
Dr. Maryam Salehi
Dr. Elaham Bakhtiari

 By:

Objective: it is believed that hemodynamic or thickness changes in choroid layer of the eye plays a fundamental role in pathogenesis of glaucoma. Studies have investigated the role of drugs and chemicals on choroid. However, we found no study that investigate the effect of antiglaucoma drugs on choroid thickness. The aim of our study is to investigate the effect of some common antiglaucoma drugs on choroid thickness.
Methods & Materials: 60 healthy young volunteers were classified into four groups: topical timololeyedrop (15), topical dorzolamideeyedrop (15), topical brimonidineeyedrop (15) and topical latanoprosteyedrop (15). The right eye of each participant received drug eyedrop and the left eye received placebo eyedrop. Choroidal thickness in  region was measured before eyedrop usage and two hours later for timolol, dorzolamide and brimonidine and 12 hours later for latanoprosteyedrop suing EDI-OCT (Heidelburg) .We planned to measure intraocular pressure but volunteers didn’t permit to do this. Data were gathered and analyzed using SPSS version 23.
Results: from all 60 cases that were enrolled in the study, data of 53 cases were in access. The mean age of volunteers was 29.2±3.9. Thirty seven (69.8%) were males and 16 (30.2%) were females. There were no significant difference regarding means or medians between groups, before and after intervention, and between intervention and control eyes (P>0.05).
Conclusion: there was no significant difference between different intervention groups after drug usage regarding median of choroid layer thickness. This was similar for means and medianin before/after comparison of intervention and control eyes.

Supervisors:
Dr. Mohammadreza Sedaghat

 By:

Objective: To investigate corneal biomechanic changes by evaluating Corvis ST and Ocular Response Analyzer (ORA) parameters after laser vision correction (LVC) by femtosecond assisted- LASIK and PRK.

Methods & Materials: Eighty six eyes were studied in 2 groups; group 1: individuals undergoing PRK (144 eyes), and group 2: individuals undergoing femtosecond assisted LASIK (24 eyes). ORA and Corvis ST Measurements were performed by an experienced technician before and 4 months after LVC.

Results: Multivariate analysis showed that corneal thickness , intraocular pressure and mean keratometric power have confounding effect on Corvis ST and ORA parameters (P=0.00). After adjustment for ablation depth, first applanation time, second applanation time, time of highest concavity and peak distance showed a significant change independently to the type of surgery; although the change was a little bit more remarkable in PRK group. Corneal Hysteresis (CH) and Corneal Resistance Factor (CRF) in ORA decreased significantly (P=0.38 and P=0.017, respectively). Intraocular pressure (IOP) didn’t change significantly in Corvis ST and ORA (P=0.452 and P=0.407, respectively).

Conclusion: Corneal deformation and reformation in response to air puff occurs slower and further after LVC. ORA and some Corvis measurements suggest reduction of corneal resistance after LVC. ORA and Corvis IOP measurement are reliable after LVC.

Keywords: Corvis ST, Ocular Response Analyzer, PRK, LASIK

Supervisors:
Dr. Siamak Zarei-Ghanavati
Dr. Alireza Eslampour

Adviser:
Dr. Saeed Shokoohi-Rad

 By:

Background: Photorefractive Keratectomy (PRK) is one of the methods of keratorefractive surgery (KRS), using the excimer laser. Nursing is one of the usage limits of PRK. The gole of this study was to evaluate the effect of nursing on post-PRK results.
Method: The current retrospective matched-cohort single blind study was performed in the Khatam-Al-Anbia Eye Hospital affiliated with Mashhad University of Medical Science. Twelve women (23 eyes) who underwent PRK 3 years ago, while they were still nursing (the study group) and twelve non nursing cases (23 eyes) matched by age, manifest refraction and operation data (control group) were covered by this study. Post PRK results and complications including myopia regression, ectasia, corneal haze were evaluated and were compared between two groups. The Independent T test, Generalized estimating equation, Fisher’s exact and 2χ tests were used for comparison of data. P-value less than 0.05 was considered statistically significant.
Results: The average nursing period before and after surgery in N were 11,25±4,60, 8,25±4,50 months. Respectively, in the study and the control groups, the average age were 29,83±1,80, 29.58±1,98, using mitomycin C: 58,3% and 75,0%, UCVA before surgery: 0,5±1,54, 0,5±1,43 and after surgery: 0,96±0,09, 0,97±0,05, BCVA before and after surgery: 1,0 and the efficacy indices were 96,97 and 97,3. After surgery, respectively, in the study and the control groups, mild dry eye were seen in 58,3% and 66,7% cases; spherical equivalent: 0,35±0,60 and 0,28±0,60 D (p=0,157), vertical trefoil (µm): 0,019±0,101 and 0,089±0,127 (p=0,02); minimal corneal thickness (µm): 457,72±46,78 and 434,54±101,97 (p=0,25); the best anterior fit sphere (D): 42,05±1,104 and 40,87±0,986 (p=0,00); posterior (D): 53,06±1,932 and 51,90±1,738 (p=0,03); cylindrical equivalent in corneal topography (D): 0,91±0,414 and 0,88±0,434 (p=0,01); simulated K, irregular astigmatism in 3 mm and 5 mm, surface regularity index, surface asymmetry index were not statistically significant. Ectasia, corneal haze and myopic regression were not seen.
Conclusion: The results of this study showed that nursing during surgery and after it has no adverse effect on the outcomes of the surgery, although further study with a higher number of cases can be helpful in generalizing the results.
Keywords: Ectasia, nursing, photorefractive keratectomy.

Supervisors:
Dr. Ramin Daneshvar

Adviser:
Dr. Mohammad Reza Fayyazi Bordbar

 By:

Objective: Glaucoma is the second leading cause of blindness in the world. Patients diagnosed with glaucoma have to deal with fear of blindness, significant decrease in quality of life and the financial burden of treatment. The aim of this study is to determine the prevalence of depression among glaucoma patients in Mashhad, Iran.
Methods & Materials: In this cross-sectional study, glaucoma patients with a known diagnosis of glaucoma for at least 6 months were recruited from a tertiary care hospital. Patients with thyroid or psychiatric disorders and people with stressful life events during the past six months were excluded. Beck depression inventory was administered to determine depression. Sociodemographic information and treatment histories were also collected.
Results: A total of 142 patients were included in this study. 142 people were enrolled as control group. There was a significantly higher prevalence of depression in patients with glaucoma compared to the control group (P value= 0.044). No significant correlation was found between sex, age group, education with depression. In addition, disease duration and severity did not contribute to depression. The self-rated vision score did not have impacts on depression statistically.
Conclusion: There is a relatively high prevalence of depression. Among glaucoma patients in Mashhad. If a glaucoma patient is at high risk of depression, a multidisciplinary management approach involving ophthalmology and psychiatry may be required.

Supervisors:
Dr. Siamak Zarei Ghanavati
Dr. Saeed Shokoohi Rad

Adviser:
Dr. Elham Bakhtiari

 By:
Reyhaneh Zahedi

Objective: To assess the effect of astigmatism’s origin (lens or cornea) on astigmatism correction after photorefractive keratectomy (PRK).
Methods & Materials: A total of 64 eyes of 37 patients who were candidates for PRK, according to inclusion criteria, were included in the study after obtaining ethical consent. Participants Based on the location of astigmatism, patients were divided into 3 groups: patients with corneal astigmatism (corneal component≥1 D and lenticular component <1 D), lenticular astigmatism (lenticular component ≥1 D and corneal component <1 D) and mixed astigmatism (lenticular component≥1 D and corneal components≥1 D). For all participants, dry and full-cycloplegic refraction (FCR), CDVA (Corrected Distance Visual Acuity), Auto KeratoRefractometery, Subjective Refraction, Topography, Aberrometry and Contrast Sensitivity Test were performed pre operatively and at least six months post-operatively. Results were analyzed and compared SPSS version 21statistical software, for all results p<0.05 was considered as significant.
Results: Post operative cycloplegic refractive cylinder was not statistically significant between groups. (P = 0.14). But topographic cylinder of lenticular group was significantly different from corneal and mixed groups postoperatively (P <0.001 and P <0.001, respectively). Also there was a significant difference between three groups for the mean difference (mean pre- post operative difference) of topographic cylinder (P <0.001). Pairwise comparisons indicate: P<0.001: Lenticular-Mixed, P<0/001: Lenticular-Corneal, P=0.04: Mixed-Corneal. But the Differences was positive in lenticular group and negative in the others. Post operative, Total HOA and HoA w / o Z400 (in 5 and 6 mm pupils) were not significantly different between three groups. (P >0.05 for all). Post operatively, there was no significantly difference between groups in none of spatial frequencies (P <0.05 for all cases).
Conclusion: PRK can be successful in correcting lenticular and mixed astigmatism as well as corneal astigmatism. Post operative visual acuity, contrast sensitivity and aberrometric findings were not significantly different between groups, which indicates similar optical results in patients with lenticular astigmatism as compared to those with corneal and mixed astigmatism.

Supervisors:
Dr. Ramin Daneshvar
Dr. Yalda Nahidi

Adviser:
Dr. Saeed Shokoohi-Rad

 By:
Farnaz Ahmadpour

Objective: Investigation and frequency comparison of dermatological manifestations in patients with pseudoexfoliative glaucoma and primary open angle glaucoma.
Methods & Materials: Between 2016 to 2017 in Khatam Alanbia hospital of Mashhad, patients with pseudoexfoliative glaucoma and the control group without pseudoexfoliation and suffering from primary open angle glaucoma, referred to skin clinic of Imam Reza hospital. The patients and the control group underwent complete skin, hair, nail and mucusal examinations. The frequency and types of manifestations of skin, hair, nail and mucus such as psoriasis, seborrheic dermatitis, etc. in patients with pseudoexfoliative glaucoma and the control group were compared and the results were analyzed by SPSS version 23.0 software.
Results: According to the analysis of outcomes, there is no significant difference in the frequency of skin manifestations between the two groups (p <0.05). The most common skin condition was seen in patients with pseudoexfoliative glaucoma and the control group was seborrheic dermatitis, dry skin and cherry angioma. Frequency of seborrheic dermatitis in patients with pseudoexfoliative glaucoma is 57.1% (12 patients) and in patients with primary open angle glaucoma (61.5%) (16 patients). In general, the frequency of seborrheic dermatitis in the two groups is not significantly different (0.05 <p). Totally, the frequency of skin dryness, Cherry angiomas, nevus, psoriasis, dermatitis, itching, seborrheic keratosis, and nonalgia paresthetica were not significantly different in two groups (p <0.05). The frequency of lentigines in the case group was significantly higher than the control group (p <0.05). In patients with open-angle glaucoma, 2 cases of vitiligo have been observed. However, this frequency was not significantly different with the group of pseudoexfoliative glaucoma (p <0.05). The mean age of patients with pseudoexfoliative glaucoma was 66.7 ± 8.3 years and in patients with open angle glaucoma was 58.4 ± 15.2 which had a significant difference (p <0.05). However, there is no significant difference between the two groups in terms of gender. The frequency of any type of skin manifestation was not significantly different between the two groups (p> 0.05). The distribution of visual acuity, intraocular pressure and the percentage of cup to disk between the two groups did not differ significantly.
Conclusion: The findings of the present study revealed no significant association between types and frequency of dermatological manifestations between patients with pseudoexfoliative glaucoma and patient with primary open angle glaucoma.

Supervisors:
Dr. Nasser Shoeibi

Adviser:
Dr. Alireza Eslampour

 By:
Mohammad Faeghinia

Objective: Cataract surgery is one of the most common surgeries in the field of ophthalmology. Knowing its precise clinical outcome is beneficial for patients who need cataract surgery. The aim of this study was to investigate the possible changes in vascular density of peripapillary and macular area, using OCT-A, after cataract surgery.
Methods & Materials: A total of 36 patients with cataract were included in the study after obtaining written informed consent according to the inclusion and exclusion criteria. Ophthalmologic examinations were performed for all patients. Prior to surgery, the imaging was performed by an OCT-A device without the need for pupil dilation. This examination was also repeated 1 week and one month after surgery. After calculating the retinal vascular density in the central macula and the optic nerve and peripapillary regions, the data were recorded in statistical software and analyzed. The other not operated eye was used for comparison.
Results: The mean ± standard deviation age of the patients was 65.39 ± 10. 14 years. The trend time variation of vascular density in the whole image region and in the upper and temporal quadrants of peripapillary region was significantly different between operated and not operated eyes (p = 0.027, p = 0.048, p = 0.049, respectively). However, no significant difference was observed in other quadrants (p >0.05). The time course of changes in RNFL thickness in operated group was significant in upper and temporal peripapillary quadrants (p = 0.006, p = 0.034, respectively). In operated eyes, macular central thickness did not show a significant difference before and after the operation (p = 0.124). But macular vascular density significantly changed in operated eyes (p = 0.001). Also, changes in macular vascular density of operated eyes was significantly different in comparison to the not operated group (p = 0.011).
Conclusion: in short term, cataract surgery can be accompanied with an increase of RNFL thickness and also vascular density in the upper and temporal quadrants of the peripapillary area and central macula. Long-term follow-up is required for better evaluation of long-term postoperative changes.

Supervisors:
Dr. Saeed Shokoohi-Rad

Advisers:
Dr. Ramin Daneshvar
Dr. Hamid Khakshoor 
Dr. Mohammad Khajedaluee

 By:
Fatemeh Zare Malek Abad

Objective: Cataract is one of the main causes of visual impairment and blindness in the world ; Although cataract surgery is highly effective and relatively safe, owing to the enormous numbers, even uncommon surgical complications could potentially harm many patients. Endophthalmitis is one of the most serious complications of cataract surgery and often results in severe visual impairment. The aim of this study was to compare the effects of pre-operative doses of betamethasone acetate (0.1%) and placebo on controlling ocular pain and inflammation after cataract surgery.
Methods & Materials: This randomized clinical trial ,double blind study was done in winter 2016 to summer 2017 and 80 patients being candidate for cataract surgery were selected in an easy non-probable method and randomly divided into two groups of 40 patients and at the end, 62 patients (31 in each group) completed the project . From 3 days before the date of operation, drops of A or B were administered 4 times a day, one drop each time. These drops contained either betamethasone 0.1% or normal saline (placebo). Postoperative follow up was performed on days 1, 7 and one month after surgery. Ocular pain was evaluated by the visual analogue scale(VAS) and the anterior segment inflammation was measured according to SUN(cell ,flare and eye redness) by slit lamp biomicroscopy.
To describe the characteristics of each group, descriptive statistical methods including central indicators, dispersion and frequency distribution were used. To compare the qualitative variables of the two groups, Chi-square test was used and to compare the quantitative variables according to the normal distribution, t-test was used. To assess the changes in pain and inflammation in each group and to compare the change process between the two groups, analysis of variance of the repeated measures were used.In each statistical test, p-value less than 0.05 was considered as a significant effect.
Results: Sixty-two patients were studied in this study that candidate for surgery with a mean age of 69.19 ± 12.80 including 51.6% female and 48.4% male. The results of the analysis are based on t-test for cell and flare variables on the next day, one week and one month after the operation. (P <0.0001). Moreover, the pain variable was significant at the first day (p <0.0001) and seventh (p = 0.04) and one month after the operation (p = 0.03).
The results of the study of changes in pain and ocular inflammation during 30 days after operation based on repeated measures test in each intervention and control group showed that in both pain variables (in the intervention group, p = 0.002 and in the control group, p <0.0001 ) And ophthalmic inflammation (in the intervention group (p = 0.002) and in the control group (p <0.0001) and flare (in the intervention group (p = 0.003) and in the control group (p <0.0001) And in the comparison of the two groups, changes in pain variables and inflammatory variables were significant (p <0.0001)
Conclusion: The use of 0.1% betamethasone acetate prior to cataract surgery has significant effect on postoperative ocular inflammation) cell & flare) and pain.
Keywords: Cataract Surgery, Betamethasone acetate, pain, ocular inflammation.

Supervisors:
Dr. Akbar Derakhshan

 By:
Abbasali nozari

Abstract

Objective: Comparison of the effectiveness of viscoelastic and balance saline solution during intraocular lens injection on increasing of intraocular pressure(Iop) in phacoemulsification cataract surgery.
Methods & Materials: In patient with nuclear sclerosan(2+,3+) cataract,during intraoculcular lens injection in group 1was used viscoelastic(VISCO) device and in group 2 was used balance sodium solution(BSS) with inserting irrigation probe of phaco machine on one stab and IOL was injected from main incision. IOP was checked in before , a week and a month after surgery with Goldman tonometer.Specular microscopy was down in before and a month after surgery.
Results: 73 parcipitant was divided to 2 group: viscoelastic include 37 patient(50.7%), balance sodium solution include 36patients(49.3%) . mean age of the study participants was 65.62± 12.5 years.mean IOP before surgery in viscoelastic was11.25± 2.40 mmhg and in BSS WAS 11.89± 2.92mmhg(p=235).mean IOP a week after surgery (IOP-1W) in visco group was 11.47± 2.43 and BSS was 10.20± 2.16mmhg.(p=0.031).mean IOP a month after surgery in visco was 11.42± 2.51mmhg and in BSS was10.37± 2.71mmhg(p=0.096) that this shows IOP between two groups had no significant difference in the before and a month after surgery but IOP a week after surgery in the BSS was lower with significant relation .
IOP in the visco had no significant relation in three date of follow up.(p=0.002) pairwise comparison of follow up times(before surgery and a week after surgery, before surgery and a month after surgery, a week after surgery and a month after surgery )show that there is no significant relation(p>0.05)
IOP in the BSS group had significant relation in three date of follow up(p=0.002). ) pairwise comparison of follow up times(, before surgery and a month after surgery, a week after surgery and a month after surgery )show that had significant relationship between before surgery and a week after surgery (p=0.000) and had significant relationship between before surgery and a month after surgery (p=0.001)but no had significant difference a week after surgery and a month after surgery .(p=0.539)
Conclusion: This study showed BSS usage result in lower IOP in a week and a month after surgery(p<0.05).this procedure may be consider as a alternative procedure.

Supervisors:
Dr. Saeed Shokoohi-Rad
Dr. Ramin Daneshvar

Advisers:
Dr. Hamid Khakshoor
Dr. Mohammad Khajedaluee

 By:
Seyedeh Zeinab Hashemi Javaheri

Abstract

Objective: Cataract is one of the main causes of visual impairment and blindness in the world and changes in the tear film and dry eye symptoms and increased macular thickness associated with reduced vision,occur after cataract surgery. The aim of this study was to compare the effects of  pre-operative doses of  betamethasone acetate (0.1%) and placebo on controlling dry eye and improving visual acuity after cataract surgery.

Methods & Materials: This randomized clinical trial ,double blind study was done in winter 2016 to summer 2017 and 80 patients being candidate for cataract surgery were selected in an easy non-probable method and randomly divided into two groups of 40 patients and at the end, 62 patients (31 in each group) completed the project . From 3 days before the date of operation, drops of A or B were administered 4 times a day, one drop each time. These drops contained either betamethasone 0.1% or normal saline (placebo). Postoperative follow up was performed on days 1, 7 and one month after surgery. Dry eyes symptoms were evaluated by the OSDI questionnaire, the amount of tear layer was assessed  with the Meniscometry test and TBUT test, and the quality of tear layer was objectively measured.

Analyzing repeated measures were used in order to study the interaction between betamethasone and time on Meniscometry, TBUT, OSDI and BCVA variables. Then these different groups were compared based on a dual approach using the Bonferroni follow-up tests. Also, for a more comprehensive analysis of the interaction between two intergroup and intragroup interactions  in each betamethasone group and placebo, the effect of different  times on the response variables were  examined using a parametric repeated size design.  In each statistical test, p-value less than 0.05 was considered as a significant effect.

Results: Sixty-two patients were studied in this study that  candidate for surgery with a mean age of 69.19 ± 12.80  including 51.6% female and 48.4% male. The results of  the analysis of  variance of  the repeated measures plot indicated that The TBUT variable are affected by  the interaction between time and betamethasone (p=0.025). With more in-depth analysis, it was determined that the significance was because of the significant difference between the pre-operative mean of TBUT and the first day after operation in the betamethasone group (p = 0.043). The results of the analysis of  variance of  the repeated measures plot indicated that the OSDI , Meniscometry and BCVA variables are not affected by the interaction between time and betamethasone. (p = 0.192), (p = 0.578), (p=0.302)

Conclusion: The use of  0.1% betamethasone acetate prior to cataract surgery has no significant effect on postoperative OSDI, Meniscometry and BCVA indices but it is effective on TBUT index.

Keywords: Cataract Surgery, Betamethasone acetate, Dry eye, Visual acuity

Supervisors:
Dr. Majid Abrishami
Dr. Naser Shoeibi

Advisers:
Dr. Elham Bakhtiari

 By:

Nafiseh Kazemi Rad
Maliheh Akbari Farkhani

Abstract

Objective: Retinopathy of prematurity (ROP) is a complex disease initiated by abnormal retinal vascularization in premature infants. ROP causes more than 10% of childhood blindness in developed countries and a preventable disease with determining its risk factors and make them least. Incidence rate and risk factors of ROP varies everywhere in the world. Then it's necessary to determine incidence rate and risk factors of ROP in our area.

Methods: In a retrospective study, data for all of premature infants who referred to ROP clinic of Khatam Al-anbia eye hospital (April2015-Sept2016) were recorded. According to inclusion and exclusion criteria 1247 files from 2000 files has been selected. All patients were examined with fundus photography retcam and indirect ophthalmoscopy. Qualitative data were analyzed by chi-square test and quantitative data were analyzed by t-test and ANOVA.

Results: Among 1247 premature infants there were 553 (44%) different stages of ROP. Data analysis showed a significant relationship between ROP and low birth weight(p value<0.0001), prematurity(p value<0.0001), NICU admission(p value<0.0001), oxygen therapy (p value<0.0001), low mean of weight gain in each week(p value<0.0001), multiple pregnancy( p value=0.049), IVF or IUI fertilization(p value<0.0001), other ocular disease(p value=0.01), surfactant therapy(p value=0.03). gender(p value=0.52), other systemic disease(p value=0.44), gravid(p value=0.46) and type of delivery (P value=o.8) didn’t have significant relationship to ROP.

Conclusion:  Among 1247 infants who referred to Khatam Al-anbia hospital, there were 553 (44%) different stages of ROP. According to the study, there is a significant relationship between ROP and variables such as low gestational age, low birth weight, oxygen consumption, low mean of weight gain in each week, NICU admission, surfactant therapy, IVF or IUI fertilization, other ocular disease and multiple pregnancy. There is no significant relationship between ROP and the gender, type of delivery, other systemic disease, and gravid.

Supervisors:
Dr. Aliakbar Sabermoghaddam

Advisers:
Dr. Mohammad Etezadrazavi
Dr. Hamed Tabesh

 By:
Dr. Hamzeh Nasiri

Abstract

Objective: Dissociated Vertical Deviation (DVD) is a challenging and prevalent type of strabismus for pediatric ophthalmologists and strabismus surgeons, often found in patients with a history of congenital esotropia.  This research has been designed to compare the incidence of DVD after the common surgical operation of inferior oblique muscle( Myectomy and Anterior Transposition), which are performed to treat inferior oblique overaction  associated with congenital esotropia.

Methods & Materials: Patients with Essential Infantile Esotropia accompanied by inferior blique overaction who underwent Myectomy( IOM) and Anterior transposition( IOAT) surgery at Khatam-ol-Anbia Hospital in Mashhad from 2001 to 2017, recalled based on medical records; and if there was no new examination, a re-examination was carried out by the first performer of the project and the presence or absence of DVD and other examinations were recorded.  Data were collected by SPSS software version 21 and analyzed.

Results: Out of 50 patients who were included in this study, IOM was performed in 21 patients (42%) and IOAT in 29 patients(58%). The mean age at operation time in the IOM group was 11.67 ± 33 and in the IOAT group was 33.10 ± 8.43 months.  The mean followup time between the time of surgery and the last examination in the IOM and IOAT groups was 3.21 ± 2 and  5.22 ± 3.58 respectively. Of the total population, 9 (18%) patients had manifest  DVD after surgery, of which 5 (23.8%) were in the IOM group and 4 (13.4%) were in the IOAT group.  In 7 patients (14%) of the total population, 1 patient (4.8%) from the IOM group and 6 patients (20.7%) from the IOAT group, there was a latent DVD.

There was no statistically significant difference between two groups in terms of gender, mean age of operation time, follow-up period, manifest and latent DVD, pre and post operative ambliopy, pre and postoperative anisometropy, preoperative esotropia and postoperative horizontal deviation.

Conclusion: No statistically significant difference was found between the two commonly used surgical methods (Myectomy and Anterior Transposition) for the treatment of inferior oblique overaction with congenital esotropia due to Post Operation DVD.

Supervisors:
Dr. Siamak Zarei-Ghanavati
Dr. Alireza Eslampour

 By:
Dr. Maral Namdari Ghorghani

Abstract

Objective: to evaluate the corneal HOAs, in first-degree relatives of keratoconus patients and compare these data with normal population.

Methods & Materials: In this prospective comparative study 210 eyes from 105 family members of 28 keratoconus patients and 210 normal eyes of 105 control subjects were enrolled. In each eye, corneal topography and Orbscan IIz was performed. Ocular aberrations were evaluated by ZyWave aberrometer. Then, topographic, tomographic and aberometric parameters were compared between 2groups.

Results: The study included 61 (58.1%) female and 44 (41.9%) male subjects with mean age of 31 years (range, 15–50 years) and 105 age-sex matched controls with normal topographic cornea who were referred to Khatam-al-Anbia Eye Center (Mashhad, Iran). In 14 of 105 first-degree relatives (13.33%) of keratoconus patients, keratoconus was diagnosed by 3 expert refractive surgeons with a male preponderance (71.5% male, 28.5%female). As regards to comparison between groups, Irregularity indices in 3mm and 5mm zone in Orbscan were significantly higher in relative group. Also other irregularity indices of TMS-4 topography including SRI, SAI, DSI, SDP, IAI were significantly higher in family members. The most prevalent pattern in the control group was the symmetric bowtie (57.1) that of the relatives group was the asymmetric bowtie (39.5%). We also detect significantly thinnest corneal pachymetry in relative group. Although higher-order aberrations in the 6-mm optical zone were increased in the KCN relatives, total aberrations were higher in controls who were refractive surgery candidates due low order aberrations. Root mean square (RMS) of all HOAs including vertical trefoil, vertical coma, horizontal coma, horizontal trefoil, quadrifoil and 4^th order spherical aberrations were significantly greater in the relative group than controls when we analyzed absolute value of data in both eyes and each eye separately.

Conclusion: Because genetic screening is limited by epigenetic factors and the multifactorial nature of KCN, the presence of a positive family history may be a clue to consider the patient as a potential case of developing KCN in the future. Due to high prevalence of undiagnosed KCN in KCN family members, keratorefractive surgery should be considered cautiously in these individuals. Thorough preoperative examination should be considered to detect subtle topographic and high order aberrations in these individuals.

KeyWords: keratoconus, familial prevalence, corneal topography, High order aberrations

Supervisors:
Dr. Mohammad-Reaz Sedaghat

 By:
Dr. Mohsen Pourshahrokhi

Abstract

Objective: ToAssess corneal Biomechanics Using Corvis ST and ORA in normal eyes & virgin cornea candidate for refractive surgery and relation between pentacam factors and these variables.
Methods & Materials: this cross sectional study was consisted of 808 patients who were referred to Dr Sedaghat eye clinic Mashhad – Iran for refractive sugery. Patients demographic data including age and sex were recorded. Both eyes evaluated for all participants. The exclusion criteria were: history of trauma, surgery, using , corneal and the presence of any ophthalmic pathologies. Biomechanical parameters were evaluated for all patients using ORA and Corvis ST. the anterior chamber volume (ACD) and central corneal thickness (CCT) we measured suing pentacam.
Results: there were significant and direct correlation between age and length 2 and velocity 2 (p=0.001 and 0.004 respectively). CCT was significantly correlated to time1, pacimetery, velocity 2 and ROC. CCT was in opposite correlation with velocity 1,time2, peak distance and DA. ACD was adversely correlated with length 2 and ROC. We also found significant correlation between CH and CRF with CCT and IOP. Finally, IOPcc negatively correlation with CH and positively with CRF. And there were correlation between the most important factor of ORA (CH) and Corvis factors include pachymetry (+0.569) RoC (+0.395) time-1 (+0.336) and IOP (+0.332) .CRF was related to pachymetry (+0.618) IOP(+0.618) , time-1(+0.616) and DA (-0.551)Pentacam variables CCT and ACD had the most effect on corneal biomecnics.
Conclusion: We reported the analysis of ORA and CorvisST parameters in a group of healthy corneas and assessed the corneal biomechanical deformation response as a function of IOP and CCT. We determined that age was significantly correlated with biochemical parameters including velocity2 and length2. IOP has an important influence on corneal biomechanical behavior leading to stiffer behavior at higher IOP. CCT is also an important factor.the most important parameters of Corvis ST were pachymetry . RoC, time-1 , IOP and DA. And pentacam parameter ACD was an effective factor on corneal biomechanics that not mentioned in previus studies. Our study recommends that age, CCT and IOP should be considered when measuring biomechanical parameters. Biomechanical comparisons of study groups with different IOPs and CCTs may lead to possible misinterpretations unless this is taken into account in the analysis.

Supervisors:
Dr. Hamid Gharaee

Adviser:
Dr. Mohamad-Reza Sedaghat
Dr.Hamed Tabesh

 By:
Dr. Samira Beigi

Abstract

Objective: Evaluation of the clear corneal main incision structure in the phacoemulsification cataract surgery and comparative assessment in two groups of junior and senior residents using the anterior segment OCT device.

Methods & Materials: 50 eyes on which cataract surgery was done entered the study, 26 and 24 of the surgeries were done by junior and senior residents respectively. The main incision structure was evaluated by the AS – OCT device the day after and 3 months from surgery.

Results: Mean Corneal thickness at the entrance to the cornea (77.64) 62.808 , at the entrance to the anterior chamber (74.93) 8.479 , incision length (18.288) 08.1569, incision angle (11.8) 16.40, superior area of incision (3.0) 54.0 , inferior area of incision (9.0) 76.0  and Limited inferior area of incision was (10.0) 24.0 , which had no significant difference between the two groups of junior and senior residents. Endothelial wound gaping and descemet detachment were observed in 13 (62%) and 24 (48%) of patients respectively on the day after surgery, which was not significantly different in the two groups of residents (p=0.514 and p=0.078 respectively). Epethelial wound gaping was seen in 3 patients (6%) , 3 patients had posterior wound retraction and 6 showed internal fibrous overgrowth (6.20%). Considering that the most prevalent incision shape was biplanar with 2nd shorter and steeper plane, the eyes were divided to 2 groups of: eyes with this type of incision shape and the rest. There was no significant difference in these two groups of shapes, between the two groups of residents (P=0.944), although there was no significant difference in descemet detachment between the resident groups (p=0.514),but endothelial wound gaping was significantly different.(p.value:0.011).

Conclusion: There was no significant difference between the two groups of senior and junior residents, regarding incisional structure and complications. More for research is needed  for determining the best incisional shape with the lowest complications and highest integrity, and it's effect on the patient's final outcome.

Supervisors:
Dr. Mir-Naghi Mousavi
Dr. Seyedeh Maryam Hosseini

Adviser:
Dr. Negar Morovatdar 

 By:
Dr. Mohammad Arjmand

Abstract

Purpose: The aim of this study was to evaluate the synergistic effect of topical cyclosporine 2% in the treatment of acute anterior uveitis (AAU).

Methods: In this prospective randomized, double-blind, comparative clinical trial, patients with acute anterior non-granulomatous, non-infectious uveitis were randomly assigned to received either topical prednisolone 1% plus topical cyclosporine 2% (group A) or topical prednisolone with placebo (group B). Moreover, Cyclosporine was administered every 6 hours for treatment group. Anterior Chamber Cell (ACC) and flare were evaluated clinically. Level of ACC and flare and side effects was recorded during follow-up. The primary outcome measure was the mean duration of resolution of inflammation (ACC <+1).

Results: Sixty eyes of 60 patients were studied, of which 30 eyes were assigned in group A and 30 eyes in group B. The average time of resolution of inflammation in group A (3, 21 days) was significantly shorter than group B (4, 25 days) (p=0.004). The average prednisone dosage used in group A was significantly lower than group B (p=0.0001). Moreover, the average increase in patients’ intraocular pressure at the end of treatment was significantly lower in group A compared with control B (p<0.05).

Conclusion: Topical cyclosporine 2% demonstrated anti-inflammatory effect on acute anterior non-granulomatous, non-infectious uveitis treatment. Therefore, it could be considered as an adjunct to topical corticosteroid (CS) for diminishing the dosage of topical CS in the management of AAU.

Keywords: Anterior Uveitis, Non-granulomatous, topical Prednisolone, Cyclosporine 2%, corticosteroid, Non-infectious, Clinical trial

Supervisors:
Dr. Akbar Derakhshan

Adviser:
Dr. Jalil Tavakol Afshari
Dr. Ramin Daneshvar
Dr. Saeed shokoohi-Rad

 By:
Dr. Javad Sadeghi Allahabadi

Abstract

Objective: Glaucoma is the second cause of irreversible blindness, which become a drawback in healthcare systems in the world. The clinical manifestations of the glaucoma include increased cup-disc ratio (CDR) >0.5 in eye examination and or impairment of vision. The open angle glaucoma is the most common type of glaucoma with the characterization of normal anterior chamber angle and the trabecular network in eye examination procedures. For preventing and treatment of Glaucoma, knowing the factors related to the onset of the disease is necessary. Therefore, the aim of present study was to study the association between C-509T polymorphism of TFG-B1 gene and the primary open angle glaucoma.
Methods & Materials: A case- control study was conducted including 112 primary open angel glaucoma patients referred to the khatam-al-anbia hospital as case group and 112 healthy participants as control group. The inclusion criteria of open angle glaucoma were the cup-disc ratio>0.5, impairment of the visual field and the intraocular pressure (IOP) above 21 mm Hg. After getting a written consent from case and control participants and recording personal and clinical information, genomic DNA were extracted form 5 milliliter of whole blood and standard PCR-RFLP was done for identification of the C-509T polymorphism of TGF-B1 gene.
Results: The results of C-509T polymorphism of TGF-B1 gene showed that the frequency of CC, CT and TT genotypes in case and control groups were 27.7%, 45.5% ,26.8%, and 44.6%, 38.4% and 17%, respectively. A significant difference was seen between the frequency of genotypes between case and control groups (P=0.022). Moreover, the results showed significant reduction of IOP of right eye (P<0.001) and left eye (P=0.008) between the first and last eye examinations.
Conclusion: it can be concluded that based on the results of present study, the C-509T polymorphism of TGF-B1 gene can be an influencing factor for Glaucoma onset. Moreover, there were no association between the CDR, IOP, visual acuity and the types of mentioned gene polymorphism. Identifying the other influencing factor for Glaucoma onse would be useful for preventing and advancing the Glaucoma treatment approaches.
Keywords: polymorphism, TGF-B1, Glaucoma, visual acuity, cup-disc ratio, intra ocular pressure

Supervisors:
Dr. Akbar Derakhshan
Dr Alireza Pasdar

 By:
Mahla Asghari

Abstract

Introduction: Sight problems are one of the most important global issues. One of the most common genetic anomalies in the eye is lens opacity, commonly referred to as cataract. Cataract is the second leading cause of visual impairment and blindness in the world. Since cataract is a heterogeneous disorder screening for pathogenic variants is very challenging.Objectives: This study aimed to identify the pathogenic variants in an Iranian large family suffering from congenital cataract.
Materials & Methods: Affected members of a family with history of congenital cataract participated in our study. After getting informed consent, accurate family history and clinical information of participants were collected through a comprehensive questionnaire, PCR products of fifteen participants (12 affected and 3 unaffected) were sent for sanger sequencing of CRYGD gene. Since no pathogenic variants were found in this gene, we performed whole exome sequencing (WES). After analysis of WES data, the causative mutation was found in one patient. We then used ARMS-PCR and sanger sequencing to check the segregation of the found variant among the all of the 51 participants (22 affected and 29 unaffected individuals).
Results: We reported three polymorphisms in CRYGD gene which are as follows: rs2242074، rs2305430 and rs2305429. Moreover, a known missense variant, c.827C>T (p.S276F), in GJA8 was identified. This mutation has been co-segregated with phenotype in the family. It was not seen in 100 unrelated healthy controls from general population.
Conclusion: The missense variant c.827C>T in GJA8 gene is associated with autosomal dominant (AD) congenital lamellar cataract with complete penetrance in the six-generation Iranian family.

Supervisors:
Dr. Majid Abrishami
Dr Alireza Eslampour

 Advisers:
Dr. Seyedeh Maryam Hosseini
Dr. Saeed Shokoohi-Rad

By:
 Dr. Rahim Saffari

Abstract

Objective: to evaluate the effects of intravitreal injection of bevacizumab on anterior chamber and central corneal thickness (CCT) using anterior segment optical coherence tomography (AS-OCT)

Methods & Materials: this cross-sectional study was included 35 eyes from 19 patients with the average age of 63.22±8.7. Patients underwent an intravitreal injection of 1.25mg/0.05ml bevacizumab. AS-OCT images were taken and measurements were compared including angle opening distance (AOD) and trabeculo-iris space area (TISA) at 750 mm from the scleral spur and CCT.

Results: the mean number of injections were 3.3±1.8. Temporal and nasal angles of AOD750 and TISA750 was not changed significantly (p<0.05). No significant difference was observed in mean IOP before injection and 24hour and 3month after last injection (p= 0.84 and 0.08 respectively). CCT was increased 24 hour and 3 month after last injection compared to pre-injection (p=0.009 and 0.03)

Conclusion: multiple intravitreal injection of bevacizumab significantly increased CCT 24 hour and 3 month after last injection. Also bevacizumab have no considerable effects on anterior chamber angles and IOP.

Supervisors:
Dr. Ramin Daneshvar
Dr. Saeed Shokoohi-Rad

By:
 Dr. Afsaneh Katiraei

Abstract

Objective: This study was performed for evaluation and comparison of optic disc, RNFL, and visual field changes in new cases of end stage renal disease, candidate for hemodialysis and control group.

Methods & Materials: This observational study was performed as a cohort on 10 new cases of end stage renal disease, candidate for hemodialysis or peritoneal dialysis and 10 control subjects attending to Khatamolanbia and Imam-Reza Hospitals in Mashad in 2016. Subjects were assessed initially and also after 6 months after dialysis for intra-ocular pressure, RNFL, optic disc changes, and visual field.

Results: The alterations in intra-ocular pressure, RNFL, optic disc, and visual field changes were same across the groups without statistically significant difference (P > 0.05).

Conclusion: Totally it may be concluded that hemodialysis would have no effects on intra-ocular pressure, RNFL, optic disc, and visual field.

Supervisors:
Dr. Mohammad Sharifi

Advisers:
Dr. Alireza Eslampour
Dr. Elham Bakhtiari

By:
Maryam Arasteh

Abstract

Objective: Congenital upper eyelid ptosis is a common benign disorder in children that can have a great impact on the aspects of beauty, psychology, or functions such as amblyopia, astigmatism, and corneal surface changes. The objective of this study is to evaluate topographic and aberrometric changes in unilateral congenital blepharoptosis, and compare it with normal fellow eyelids.
Methods & Materials: This descriptive analytic study was conducted in 16 cosecutive patients with less than 30 years of age, with congenital unilateral blepharoptosis who had inclusion criteria of this study. Compelete ocular examination were performed in all patients. Patients were introduced to the paraclinical unit to perform corneal imaging. Topographic, orb scan and aberrometric maps were done in ptotic eyelid and normal fellow eyes (32 eyes). Independent t-test, paired t-test and ANOVA were used to analyze the data
Results: Mean age was 21.31±6.31 years. Mean MRD1 was 1.44±0.6 mm in ptotic eye. Mean change in MRD, between ptotic and normal fellow eyelids were statistically significant p(0.00). Mean aberrometric parameters between ptotic and normal eyelids did not show significant change statistically. Mean topographic parameters showed significant change statistically, such as Kf (p:0.03), Cyl (p:0.03), SRI (p:0.00), IAI (p:0.00). Orb scan parameters such as Sim’s Ks and astigmatic power showed statistically significant difference between ptotic and normal eyelids.
The severity of ptosis had no significant effect on aberrometric and topographic change. In those ptotic eyelids with ≥ 1 D astigmatism, aberrometric parameter such as HO w/o Z400 showed significant difference between ptotic and normal fellow eyes p( 0.03). In those eyelids with ≥1.5 D astigmatism, aberrometric parameters such as Higher order 6mm (p:0.02), HO w/o Z400 (p:0.01), Qudrafoil (p:0.05) and Horizental coma (p:0.03), showed significant difference statistically.
Conclusion: Unilateral congenital blepharoptosis may cause aberrometric and topographic changes between ptotic and normal fellow eyes, especially when corneal astigmatism was ≥ 1 D. These changes shoud be considered before keratorefractive surgery in these pationts.

Supervisors:
Dr. Mir-Naghi Mousavi
Dr. Naser Shoeibi

By:

Dr. Nasrin Tahvildar Nezhad

Abstract

Objective: Ramadan is the holiest mooth in Muslim’s calendar. In Ramadan muslim adults fast from sunrise to sunset and are required to refrain from oral intake of food, water, beverages and smoking, the objective of the present study was to evaluate and to compare the effect of religious fasting on biometric indices in healthy individuals during Ramadan.
Methods & Materials: 44 healty volunteers (32 man and 12 woman) participated in the study. Patients with systemic diseases an eyes with pathology or previous surgery and contact lens woering were excluded. Ocular biometric characteristics was measured with non contact optical biometry (LS international HAAG STRET, LENS TAR, 900, made in switzer land), and choroidal Thickness was measured with EDI- OCT (Heidel berg Spectralis OCT), and Anterior chamber angle was measured with Anterior OCT (Heidelberg Engineering, spectralis HRA + OCT, Rev. 1.6.00), During Ramadan; at one hour before sunset and one hour after sunset, an one mooth after Ramadan.
Results: Comparison of measurements between fasting and non fasting periods during Ramadan and one month after Ramadan Relived significantly differences in Lens thickness (P-Value OD= 0.000, OS= 0.043), Axial Length OS (P=0.04), choroidal thickness (OS) (P=0.02) measurements at fasting state (evening) and fed state (eveniny). No statistically significant difference could be found in the Axial Length(os), central corneal thickness (OU), Aquears depth (OU), K1 and K2 radii of curvature (ou), corneal Astigmatism (OU), IOL calculation with SRKT formula (OU), choroidal thickness (OD) and AOD 500m temporal & Nosal (OU), ACA Temporal and Nasal (OU), between intervals.
Conclusion: Our results reveal that Islamic Ramadan fasting is associated with statistically significant alteration in Lens thickness, Axial Length and choroidal thickness measurements. There fore, Ramadan fasting can effect the biometrical parameters, such as Axial length and Lens thickness, These resuls might lead to post cataract surgery refrective errors. According to this study we suggested IOL power calculation is better to done after Ramadan that all of parameters return to baseline.

Supervisors:
Dr. Ramin Daneshvar

Adviser:
Dr. Maryam Salehi

By:
Dr. Mojtaba Ghadamzadeh

Abstract

Objective and aim: Glaucoma is called to a group of eye disorders that can lead to progressive damage of the optic nerve. Given the importance of this disease and insufficient knowledge about the effectiveness of different surgical procedures towards each other, and the need for more effective treatment protocols, this study seems necessary. In the present study, we investigate the morphological changes of anterior chamber after phacoemulsification in patients with primary angle closure glaucoma (PACG) and simultaneous cataract by using anterior segment optical coherence tomography (AS-OCT) compared to phacotrabeculectomy.
Methods: All patients initially underwent Gonioscopy. The patients were then randomly divided into two groups using random numbers table. The first group included 25 patients undergoing phacoemulsification and simultaneous intraocular lens implantation and goniosynechiolysis (phaco+IOL+GSL) and the second group included 27 patients undergoing phacotrabeculectomy and simultaneous intraocular lens implantation (phacotrab + IOL). All patients were followed up after one week, one month and 6 months postoperation.
Results: The mean age of patients was 59.3 ± 5.9 (age range: 49-75). Of the study population, there were 15 male and 10 female in the 1st group (phaco+IOL+GSL), and 15 male and 12 female in the 2nd group (phacotrab+IOL). The results showed that the mean difference of angle opening distance (AOD500) and trabecula-iris space area (TISA500), and trabecula-iris angel (TIA500) at one week, one month and six months intervals before and after surgery was statistically significant (P-value <0.05). The mean difference of intergroup and intragroup variables was also statistically significant (P-value <0.05).
Discussion: Given the significant difference of AOD500 and TISA500 and TIA500 before and after the surgery, and the significant change in the morphology of anterior segment by AS-OCT, it is suggested that this method could replace other methods.
Keywords: glaucoma, phacotrabeculectomy, phacoemulsificatio

Supervisors:
Dr. Alireza Eslampour

Adviser:
Dr. Siamak Zarei-Ghanavati

By:
Seyed Javad Jafarian kalat

Abstract

Background: Nowadays, surgery of refractive errors is most common eye surgery in all around the world. Since that after of this surgery, disappears the continuity of the corneal epithelium, to prevention of infection used from Levofloxacin antibiotic drops such as prophylaxis. This drug is available in two forms include multi-dose (Containing preservative Benzalkonium chloride) and single-dose (without preservative). In this study we will do a comparative analysis about the effect of single-dose of levofloxacin with type of multi-dose of that on signs and symptoms of eye in patients after surgery of Photorefractive Keratectomy (PRK).
Method: This randomized clinical trial study was done on patients with refractive errors that were referred to clinic of eye in Khatamolanbiya hospital, Mashhad which were candidate for PRK surgery. Patients were randomly allocated to one of the two treatment groups with multi-dose levofloxacin drop or single-dose treatment. On days 1, 3, 5 after of surgery, pain level (based on VAS), red eye or inflammation of conjunctivitis, eyelid edema, photophobia and size of epithelium defect was recorded. Chi-square test and independent t-test has been used for statistical analysis by SPSS version 18.
Results: This study was done on the 60 patients (14 men / 46 women) with an average age of 29.1 ± 6.0 years in two groups of 30 patients. Two groups were matched in age and sex. In the first days after PRK, these two groups have not significant differences in eye symptoms. In the third day after the surgery, mean score of eyelid edema (p=0.317), pain (P=0.354), redness and injunction of conjunctiva (P=0.409), individual performance limitation (P=0.154) have not a significant statistically difference and only the average score of photophobia in multi-dose group was more than single-dose group. (0.96± 0.18 against 0.62±0.49 and P=0.001). Eyelid edema was not observed in none of patients on the fifth day after surgery and these two groups have not significant statistically difference together according to other eye symptoms. The average size of epithelium defect did not witness a significant different between two groups in the first (P=0.937), third (P= 0.154), and fifth day (P=0.156) after PRK. However, on the fifth day after surgery in 4 patients (13.4٪) of multi-dose group and one patient (3.3٪) in single-dose group epithelium defect was observed.
Conclusion: Based on the results it seem that preservative material of Benzalconium chloride does not make a significant difference in incidence of eye symptoms during 5 days after PRK surgery; and two groups of single dose levofloxacin drop consumer and multi-dose ones show almost the same level of symptoms.
Keywords: Photorefractive Keratectomy, Benzalkonium chloride, Levofloxacin

Supervisors:
Dr. Siamak Zarei-Ghanavati
Dr. Ramin Daneshvar

By:
Seyed Hamed Hoseini khah Menshadi

Abstract

Introduction: In keratoconuspatients, where there are irregularities in the cornea, one of the challenges is measuring the intraocular pressure (IOP). This non-inflammatory progressive disease leads to thinning of cornea. Currently, considerable advances have been made by the use of intracorneal Rings segment. As a result, considering the change that intracorneal Rings segment can make inside the cornea, measuring the IOPbyvarious tonometer’s instruments can determine whether there is any difference between various tonometer’s.
Method: This study has been conducted, in Khatam-al-Anbiahospital in Mashhad medical school, on 26 patients with Keratoconus that went through intracorneal Rings surgery. The samples were chosen randomly. In this study, the data was recorded in check-lists provided to the personwho measured IOP, and then, analyzed (or processed) using the SPSS software.
Results: In this study, 26 samples including 13 men and 13 women were evaluated on IOP after intracorneal Rings segment surgery by different tonometers. Based on ANOVA test, the average of IOP measured by the different tonometersin eyes with Ring was significant (p<0/01). Based on ANOVA test, the average of IOP measured by the different tonometers in eyes without Ring was significant (p<0/01). Based on ANOVA test the difference between the mean values measured by Tono-Pen of the eyes with Ring around the cornea was significant (p<0/01).Based on ANOVA test the difference between the mean values measured by Tono-Pen of the eyes without Ring around the cornea was significant (p <0/01).In this study it was shown thatin eyes with Ring on the basis of analysis of ANOVA and Tukey's Post Hoc, those values measured by different tonometers leaded to the fact that, there was a significant relationshipbetween these tonometers. (P <0/01)IOP was measured in the eyes with ring bytonometers like Tono-pen, ORAIOPcc and ATT(goldmann) and Corvisthe values were almost the same. While the result of measuring ORAIOPgg was different from others.In this study it was shown that in the eyes without Ring on the basis of analysis ANOVA and Tukey Post Hoc, there was a significant relationship between the values measured by different tonometers(P <0/01). In the eyes without Ring, IOP measured bytonometers like Tono-Pen, ORAIOPcc and ATT (goldmann) and Corviswere close to each other, whereas the values measured by ORAIOPggwas only closeto ATT(goldmann) .There was a significant relationship between the IOP measured in the eyes with Ring and without Ring, based on paired sample T test (P<0/01).
Conclusion: In the eyes with Ring, the relationship between the measuredIOP by different tonometers were significant, the lowest measured IOP was ORAIOPg with an average of 9/26 and the highest measured IOP was Tono-pen with average of 14/69 .In the eyes without Ring, the relationship between the measured IOP by different tonometers were significant, the lowest measured IOP was ORAIOPg with an average of 11/35 and the highest amount of tonometers wasTono-pen with average of 14/22.
Keywords: Keratoconus – IOP – intracorneal Ring – tonometers

Supervisors:
Dr. Ramin Daneshvar

Adviser:
Dr. Mir- Naghi Mousavi

By:
Fatemeh Gholami

Abstract

 

Supervisors:
Dr. Siamak Zarei-Ghanavati

Adviser:
Dr. Alireza Eslampour

By:
Mostafa Abrishami

Abstract

 

Supervisors:
Dr. Akbar Derakhshan

Adviser:
Dr. Alireza Eslampour

By:
Dr. Esmaeil safinezhad

Abstract

Introduction: Bevacizumab (Avastin), as an effectiveness treatment modality, is currently used in patients with various ocular disease. However the results have been promising, the use of bevacizumab in the treatment of ocular disease is an off-label application. Hence, the aim of this study was to systematically review the effectiveness of intravitreal injection of bevacizumab on various ocular tissues, especially corneal endothelial cells.
Methods: The articles related to the effect of application of Avastin in the treatment of ophthalmic diseases and especially its effect on corneal endothelial cells were collected and reviewed. We searched PubMed, Google scholar, and Scopus databases and used Avastin, ocular diseases and corneal endothelial cells as search keywords.
Result: Of all 55 articles found in all databases, only 10 were relevant to the purpose of this study, and 45 articles were excluded in several step by step process of article selection according to the inclusion/exclusion criteria. The results revealed that intracameral bevacizumab injection caused no changes in specular microscopy and corneal pachymetry. Moreover, it had no significant toxicity on corneal endothelial cells.
Discussion: Effectiveness of bevacizumab as a new modality in the treatment of different ophthalmic diseases have been suggested. Recent data on both human and animal models showed that intravitreal injection of bevacizumab resulted in no significant toxicity on various ocular cells, and it could be considered as a suitable therapeutic approach in clinical use.
Conclusion: According to the results of included documents, bevacizumab was not toxic to corneal endothelial cells at various clinically relevant doses.

Supervisors:
Dr. Hamid Gharaee
Dr. Mohammad Reza Sedaghat

By:
Dr. Saeed Banan

Abstract

Background: The purpose of this study was to determine whether application of a risk stratification system during preoperative assessment of cataract patients and subsequent allocation of patients to ophthalmology residents with matching experience may reduce intraoperative complications.
Methods: 475 patient undergoing phacoemulsification cataract surgery were assigned to two groups, ie, group 1 (n = 232 patients) and group 2 (n = 543 patients). Patients from group 1 were assigned to 2 risk groups surgery according to Najjar-Awwad cataract surgery risk scor (low risk with risk score 2-6, high risk with risk score more than 6) according to risk factors established during their preoperative assessment and were respectively allocated to 3rd year resident and 4th year residents.Patients from group 2 were allocated to residents with varying experience with only a rough estimate of the complexity of their surgery. Data were collected and entered into a computerized database. The intraoperative complication rate was calculated for each group.
Results: The intraoperative complication rate was not significantly lower in group 1 than in group 2. 4th year residents have significantly lower complications than 3rd year residens in lowrisk and high risk cases(p value<0.001).difference bet ween complicated surgeries of 3rd and 4th year residents was not significant in patients with risk score <6(p value=0.47).
Conclusion: Our study demonstrates that allocation of cataract patients to residents matched for experience according to Najjar-Awwad cataract surgery risk scor may result in lower complications if beginner resideny choose their patients from low risk cases.
Keywords: phacoemulsification , complications , resident

Supervisors:
Dr. Siamak zarei-Ghanavati

Adviser:
Dr. Mohammad Etezad-Razavi

By:
Dr. Razieh Bayani

Abstract

 

Supervisors:
Dr. Akbar Derakhshan

Adviser:
Dr. Ramin Daneshvar
Dr. Hamid Reza Bahrami

By:
Dr. Amir Ghaffarian Mashhadi Nezhad

Abstract

 

Supervisors:
Dr. Ramin Daneshvar

Adviser:
Dr. Alireza Eslampour

By:
Dr. Esmaeil Babaei

Abstract

 

Supervisors:
Dr. Ali akbar Saber Moghaddam
Dr. Ramin Daneshvar

By:
Dr. Mahdi Hashemi

Abstract

Objective: Evaluation of IOP altration in restrictive strabismic patients and compare it with nonrestrictive strabismic patients before and after strabismus surgery.

Material and Methods: Fifty six eyes of 41 patients whose diagnosis was strabismus (restrictive or non-restrictive) and had undergone extra ocular recession or resection surgery for correction of strabismus were enrolled in the study. IOP was measured before and after surgery. The changes in IOP were analyzed and compared between the two kind of strabismus.

Results: Four eyes (7.1%) had restrictive strabismus and the others were non-restrictive. The mean age at surgery was 13.83 (SD 7.63, range 3–32) years and 57% were male. 5% of our patients (3 cases) underwent resection of the muscles and 55% (32 cases) underwent recession and 24 %( 14 cases) had both surgical methods and other 15 %(9 cases) had other methods. The mean baseline IOP was 12 (SD 87.1) mm Hg when measured immediately before surgery and 11(SD 1.16) mm Hg when during surgery, which decreasing to 10.32 (SD 2.59) mm Hg when measured 5 days post op. and 11.15 (SD 1.59) mm Hg and 11.53 (SD 1.92) mm Hg when measured one month and also, six months after surgery ; respectively.  The mean IOP reduction was 1.8 (SD 2.8) mm Hg, and in all these measurements, there was not statistically significant difference between restrictive and non-restrictive groups (p0.05) .However, the mean IOP also showed no significant reduction, when measured after the muscles had been cut off or recessed from the globe (p, 0.48);but it was showed significant statistical difference between the 1^st and 6^th months after surgery(p0.05).

Conclusions: The changes in IOP seen after strabismus surgery is not statistically meaningful and also ,is not significantly differ between restrictive and non-restrictive strabismus .

Keywords: intraocular pressure, strabismus surgery, restrictive strabismus.

Supervisors:
Dr. Naser Shoeibi

Advisers: 
Dr. Touka Banaee

By:
Dr. Mehran Mehdizadeh

Abstract

Introduction: Uveitis is one of the most common and complicated eye diseases. because of the special eye structure and presence of the eye barriers, topical drops are not an effective treatment for the posterior uveitis. intra or inter-orbital injections are indicated as the treatment of posterior uveitis which are aggressive and occasionally cause some complications. Also Systemic drug application can lead to systemic complications. recently in order to decrease drug side effects and enhance drug penetration, some methods such as iontophoresis and providing liposomal form of the drug are applied. In this study we have investigated the effect of iontophoresis on the increasing intraviteral concentration of the cyclosporine after applying liposomal form of cyclosporine in the rabbit eye.

Method: 20 rabbits were divided into 5 groups. Two groups were under cathodic and anodic iontophoresis of liposomal form of cyclosporine in the right eye and applying liposomal form of cyclosporine on the left eye without iontophoresis. In the other two groups cathodic and anodic iontophoresis of free form of cyclosporine was done and free form of cyclosporine was applied on the left eye without iontophoresis. In the control group intraviteral injection of liposomal form of cyclosporine was done in two eyes and in the other 6 eyes neither free or liposomal form of cyclosporine nor iontophoresis was applied and then sampling was done. Iontophoresis was done with current of 10 mA for 5 minutes. Sampling of vitreous was done after 24 hours and concentration of the cyclosporine was determined by Elisa method.

Results: Cyclosporine concentration after intraviteral injection of liposomal form of cyclosporine in the control group was more than 5000 ng/ml. in the rest of the groups cyclosporine concentration was not detectable. Non of the animals were died during the study. No orbital injury was observed due to applying electric current or use of free or liposomal form of cyclosporine on the eye. Burning of the rabbit ear in the place of electrode attachment was observed.

Conclusion: Trans corneal and trans sclera iontophoresis with 10 mA current for 5 minutes is not effective for increasing the penetration of the free or liposomal form of cyclosporine in the rabbit eye. Due to the benefits of this method and not identifying all of the effective factors, it might be possible to transport the cyclosporine as an effective drug for uveitis treatment by changing the parameters of this study such as the iontophoresis current, time, cyclosporine concentration, electric charge, liposome size and other factors affecting the iontophoresis.

Key words: Iontophoresis, Cyclosporine, Iiposome,Vitreous.

Supervisors:
Dr. Naser Shoeibi
Dr. Ramin Daneshvar

By:
Dr. Habib Jafari

Abstract

Background: Intravitreal injections of anti-vascular endothelial growth factors (anti-VEGFs)  become more popular quickly in recent years . Bevacizumab is an anti- vascular endothelial growth factor  agent (anti-VEGF) used to treat choroidal neovascularization and retinal vascular disorders. Rarely long lasting ocular adverse events are reported in the intravitreal injection of this drug that include intraocular inflammation, retinal tears, vitreous hemorrhage, endophtalmitis  and lens changes. One important concern about intravitreal injection of anti-VEGF drug is intraocular pressure (IOP) elevation. There are two kinds of IOP elevation .The first  is an acute elevation of IOP (after few minutes) and the second is delayed IOP elevation (after few months). Acute IOP elevation after intravitreal injection of bevacizumab has potential risk of nerve fiber loss of optic nerve result in decreased vision. . IOP elevation immediately after injection is significantly high and seems to has potential risk for optic nerve fiber loss but fortunately this IOP elevation seems to be transient in most of studies.

Method: This was a prospective , single center ,randomized clinical trial .Seventy four patients were randomly chosen from those who seen at a retinal center of Khatam’s eye hospital. Participant were divided randomly in 5 equal groups. Group 1 received  timolol(2 drops) whereas group 2 received  brimonidine(2 drops) .Group 3  received 250mg oral acetazolamide 2hours before injection. Group 4 received 1.5g/kg intravenous manitol 2 hours before injection and finally group5 (control group) did not received any medication before bevacizumab injection.

Results: The pattern of acute elevation of IOP in all 5 group were similar to each other and there is no significant difference between them.(p = 0.975)

Conclusion: Usage of anti glaucoma agents before intra vitreal avastin injection could not affect the normal pattern of acute IOP elevation.

Keywords: anti-VEGF, Bevacizumab , IOP(intraocular pressure)

Supervisors:
Dr. Mohammad Etezad Razavi

Advisors:
Dr. Alireza Eslampour
Dr. Mohammad Gharavi

By:
Dr. Somayeh Tafaghodi Yousefi

Abstract

Introduction: Management of anisometropic amblyopia in children remains a challenge to pediatric ophthalmologists. We sought to determine photorefractive keratectomy (PRK) is effective method for correcting amblyopiogenic refractive errors in children.

Methods and materials: Twelve children, 6 to 17 years old, 7 with anisohypropic amblyopia, 3 with anisomyopia and 2 with astigmatic amblyopia that were noncompliant with conventional therapy with glasses or contact lenses. The examination included cycloplegic refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), biomicroscopy grading of postoperative haze, binocular vision (BV), and stereopsis were performed preoperatively and 1,3,6,12 month postopratively. Data analyses, including parametric and nonparametric tests were undertaken using the SPSS 16 software. A P value < 0.05 was regarded as statistically significant.

Results: Mean age was 8.83±3.1; four (33.3%) female and eight (66.6%) were male.In myopia group with SE of -5.67±1.75 preopratively after 1 year follow up reach to -0.25 ±0.43 diopter, in hyperopic group SE of +5.75±1.11 reach to 2.32±1.84 and in astigmatism group -2.25±0.35 reach to 0.5+0.35 1 year postoperation. All 3 myopic, 2 astigmatic and 5 of 7 hyperopic patients reached to target SE. Among 7 hyperopic groups 2 patients SE were within 3 diopter of   target.

Uncorrected preooprationV.A from 0.25±0.12 decimal reach to 0.59±0.25 with mean change of 0.34±0.08. Corrected preoprationV.A from 0.5±0.2 decimal reach to 0.67±0.26 after 1 year. 86% of patient had 1 line or more increase in UCVA and 42% had 3 lines or more change. 66.7% of patien had 1 line and more increase in BCVA and 41% had 3 line or more after 1 year follow up. 1 patient had 1 line decrease in BCVA.

The most change was seen in astigmatism group that V.A reach to 10/10 and the least change were seen in hyopropic group.

In most of the patients stereopsis was improved with mean 341.67±245 second of arc to 166±87.52 in 1 year follow up. Just 1 patient‘s  suppressed fusion converted to normal.No corneal haze was detected.

Conclusion: PRK could have good results in amblyopia therapy, also it is safe and helpful in anisometropic amblyopia.

Keywords: anisometropic amblyopia, photorefractive keratectomy, best-corrected visual acuity.

Supervisors:
Dr. Tooka Banaee 
Dr. Ramin Daneshvar

Advisers:
Dr. Seyedeh Maryam Hoseini
Dr. Alireza Eslampour

By:
Dr. Masoud Shafiee

Abstract

Background: As intraocular inflammation has many adverse effects on the delicate intraocular structures and cells, prompt control of inflammation is desirable. In this study we are going to evaluate if addition of topical diclofenac to topical prednisolone treatment of acute anterior uveitis, results in better control of inflammation.
Methods: In this pilot randomized clinical study, 60 patients with acute non-granulomatous anterior uveitis were randomly assigned to treatment with topical prednisolone monotherapy or topical prednisolone plus topical diclofenac. Inflammation of the involved eyes was documented at baseline and 2 weeks after the initiation of treatment and 1 week after improvement according to the SUN working group classification. In addition central corneal thickness and specular ciomicroscopy was done in these 3 visits.
Results: Mean age of patients was 31.45±8.81 and 23 cases were female (38.3%). At baseline, mean LogMAR of vision in the monotherapy and combination groups were 0.51±0.19 and 0.56±0.23 (p=0.43) respectively. The inflammatory score of the two groups was not significantly different (p=0.26). After 2 weeks of treatment mean LogMAR of VA was 0.25±0.09 in the monotherapy and 0.21±0.10 in the combination group (p=0.65), while inflammatory grade was significantly lower in the latter group (p<0.001) there was no significant difference in central corneal thickness and specular biomicroscopic indices between two groups.
Conclision: according to results, diclofenac sodium ophthalmic solution can be used as an adjuvant therapy for acute anterior uveitis; while there is no correlation between the degree of anterior chamber reaction and central corneal thickness.
Keywords: Eye drop diclofenac sodium, Eye drop prednisolone acetate, Acute anterior uveitis

Supervisors:
Dr. Ali-Akbar Saber-Moghaddam
Dr. Akbar Derakhshan

Advisers:
Dr. Siamak Zarei-Ghanavati
Dr. Mohammad-Taghi Shakeri

By:
Mehran Alirezaee

Abstract

 

Supervisors:
Dr. Ali-Akbar Saber-Moghaddam
Dr. Ramin Daneshvar

By:

Mehrdad Motamed Shariati

Abstract

 

Supervisors:
Dr. Mir-Naghi mousavi
Dr. Hamid Gharaee

By:

Dr. Taher Soleimani

Abstract

 

Supervisors:
Dr. Ali-Akbar SaberMoghddam
Dr. Mir-Naghi mousavi

Advisers:
Dr. Naser Shoeibi

By:
Niloofar Sabouri Yazdi

Abstract

 

Supervisors:
Dr. Akbar Derakhshan
Dr. Majid Abrishami

Advisers:
Dr. Mohammad Khajedaluee

By:
Dr. Arash Omid Tabrizi

Abstract

Background: diabetic neuropathy can affect the corneal nerve fibers which are a part of the tear secretion reflex tear‬ p time, basic tear secretion (schirmer) -film break-up time(TBUT) and tear osmolarity test with tearlab osmometer were performed for both study and control groups. HbA1c was checked at the same time.
Method: fifty diabetic patients and twenty healthy individuals as control group participated in the study according to the inclusion and exclusion criteria. Complete eye examination including ophthalmoscopy, basic tear secretion(schirmer), tear-film break-film disorder and Dry eye syndrome. Tear osmolarity measurement has proven to be a sensitive test for dry eye diagnosis and its results confirms the results of schirmer and ear.
Results: Mean tear osmolarity was 294mosmol/L in the study group and 291.4msomol/L in the control group and the difference wasnt significant (P=0.456). There was no sex or age privilege in tear osmolarity among patients (P>0.05). There was no significant relation between duration of diabetes, stage of diabetic retinopathy and mean TBUT with tear osmolarity (p>0.05). The schirmer test results and HbA1c were significantly related to the tear osmolarity(P=0.004 for both).
Conclusion: Just suffering from diabetes, is not a reason for a higher than normal tear osmolarity. But the poorer the blood sugar is controlled, the higher tear osmolarity and risk of dry eye symptoms. Tear osmolarity test results are compatible with basic tear secretion (schirmer) test.
Keywords: Diabetes Mellitus, tear osmolarity, tear-film break-up time tests. Until now, tears osmolarity test has not been compared between diabetic patients and normal population. 

Supervisors:
Dr. Hamid Gharaee
Dr. Mohammad Sharifi

By:
Dr. Keyhan Bashiri

Abstract

Purpose: to compare high-order aberrations before and after horizontal extraocular muscle surgery.

Materials and Methods: 48 eyes of 25 patients with horizontal deviation were enrolled in this prospective study. Individuals with exotropia underwent bilateral lateral rectus muscle recession (BLR) & esotropic ones received bilateral medial rectus recession (BMR) or R&R for whom showed dominancy in fixation behaviors. Wave front analysis and corneal tomography using Technolas Zywave Aberrometer and Orb scan IIz respectively was performed before, at 1st & 3rd month following surgery.

Results: Root mean square (RMS) of high-order aberrations (HOAs) increased significantly at 1st month after surgery (P value= 0.001) and decreased by third postop month. A deeper evaluation of Zernike coefficients up to 5th order terms showed a statistically significant increase in RMS of Horizontal & Vertical Coma (HC & VC) by first post-op month (P value= 0.017 , P value = 0.43 ), where VC  returned to its baseline values by month 3  but HC remained increased until the third post-op month (P value = 0.041). Spherical aberration changes were similar to VC and RMS of HOA (P value = 0.027). Corneal tomography using (Busch & Lomb) showed increase of irregularity at corneal 5mm zone in the first month and returned to its baseline values by month three.

Conclusion: Our findings showed an early increase in ocular HOAs & corneal irregularity following horizontal rectus muscle surgery that disappeared as the time passed. These results previous reports of transient surgically induced astigmatism after strabismus surgery.

Keywords: high-order aberrations, strabismus surgery, astigmatism, tomography, aberrometry.

Supervisors:
Dr. Mohammad Sharifi

By:
Zohreh Parang Sabzevar

Abstract

Background: Childhood intermittent exotropia (IXT) is the most common type of exotropia. In Asia, the prevalence of intermittent exotropia is more than esotropia and it occurs more commonly than in the US. The surgical therapy of IXT with the purpose of ocular alignment is performed in order to provide a convenient binocular vision. One of the most common surgical procedures with the purpose of IXT correction is the recession of lateral rectus muscle. The aim of the present study is to investigate the success rate of the augmented compared with conventional surgical procedures, as well as, to compare the percentage of patients with excessive or lesser alignment postoperatively.
Method: The medical records of 40 consecutive patients, 18 males and 22 females, who had undergone surgery for basic intermittent exotropia between June 2011 and September 2014 were retrospectively reviewed. The inclusion criteria were as follows: (1) intermittent exotropia more than 20 prism diopter; (2) an absence of lateral incomitance of more than 10; (3) patient between 5 and 30 years of age; (4) no past history of systemic and ophthalmic diseases, surgery and trauma; .all patient were followed-up for at least 6 months after surgery. Then, the patients were randomly divided into two groups according to the type of surgery: conventional symmetric lateral rectus recessions (n = 20) and augmented bilateral rectus recession (n= 20). A complete examination of each patient was done.
Results: There were no significant differences between the mean alignment, the follow-up period, or the age of the patients who had undergone either of the two surgical procedures (P>0.05). On the first post-operative week, the observed overcorrection 10∆ esotropia was higher in those subjects who had under-gone augmented surgery as compared with those who had under-gone conventional surgery (n=2 Vs 1, respectively). At last follow-up, the success rate was significantly higher in the augmented bilateral rectus surgery group (65% vs. 30%, p=0.027). In addition, There was a significant difference in the rate of under-correction between the two groups (n=12 Vs. 6, p=0.03); the group having had augmented surgery had significantly lesser under-correction than the group who had conventional surgery.
Conclusion: In conclusion, in children with primary large-angle exotropia, the long-term rate of successful ocular alignment after augmented bilateral rectus recession was 65.0%, and regarding to the long-term surgical outcomes the augmented bilateral rectus recession may be preferred to conventional method. Bilateral procedure resulted in more favorable long-term outcomes than the conventional method.
Keywords: Intermittent Exotropia, Recess Augmented Method, Conventional Method

Supervisors:
Dr. Hamid Gharaee

By:
faezeh saffari

Abstract

 

Supervisors:
Dr. Ali-Akbar Saber Moghaddam
Dr. Abbas Kargozar

By:
Dr. Sattar Heidari

Abstract

 

Supervisors:
Dr. Hamid Khakshour
Dr. Mohammad Etezad-Razavi

By:
Dr. Samaneh Davoudi-Moghaddam

Abstract

Background: Corneal intercept of the visual axis and the entrance pupil center have the larger distance in hyperopic patients. Their correct ablation has great importance. We studied photorefractive keratectomy on hyperopic high angle kappa patients by adjusted head rotation. Therapeutic results and Visual Function after ablation were evaluated.
Methods: In case series 80 hyperopic high angle kappa (>5) eyes were ablated based on new coaxially sighted corneal reflex centeration adjusted by head rotation. The results of Topography, Orbscan, aberrometry and optometry tests pre operation and post operation, and contrast sensitivity post operation and also the data of the operation itself were evaluated by SPSS software.
Results: in 80 eyes (57.5% female) with average age 39.23±10.22 had following results: centeration was achieved in 92.5%. Pre operation UCVA logMAR was 0.71±o.28 that improved 0.07±0.09 one month post operation. Spherical refractive error average since +3.9±1.28 improved +0.27±0.23. Regression happened 6 month after operation but it was clinical stability up to 1 year follow up. (p<0.0001) In 100% of patients UCVA and BCVA were better 20/40 and 20/30 1 year after operation, respectively. Irregular astigmatism had a statistically significant increment (p<0.001) and contrast sensitivity significantly decreased. (p<0.0001) Post operation HoRMS and HoWo Z400 were multipled 1.45 and 1.55 than pre operation, respectively. (p<0.0001)
Conclusion: Photorefractive keratectomy on hyperopic high angle kappa patients by adjusted head rotation was caused centeration in the most of patients.
KeyWords: Photorefractive keratectomy, visual function, Hyperopia, kappa angle, Photoablation

Supervisors:
Dr. Ali-Akbar Saber Moghaddam

Advisers:
Dr. Naser Shoeibi
Dr. Maryam Salehi
Dr. Hamid-Reza Pour-Reza

By:
Dr. Saeed Noshirvanpour

Abstract

 

Introduction: In this study we aimed to investigate the Stability and antibacterial potency of Fortified solutions of vancomycin, amikacin, cefazolin, ceftazidim prepareted in 4 diluents , Stored at two temperatures of 4 and 24week period. But MIC of Amikacin, ceftazidim was change after 7 days in two tempreture. PH , osmplarity of all solutions was stable for 4 weeks in two tempreture (but for cefazolin was not stable ). Osmolarity of Snotears artificial tear was higher than of BSS, NS0/9 , DW5 and higher than the level of normal tear films. Visual inspection revealed that all solution remained clear , particle free, colorless but the color of ceftazidim solutions was change in 24- C for 0, 4, 7, 14 and 28 days after preparation of the solutions.
Material and Method: The solutions with vancomycin (5 ), amikacin (2 ), ceftazidim (5 ), cefazolin(5 ) antibiotics reconstructedin BSS, DW5 , Sodium chloride, were evaluated at 0, 4, 7, 14 and 28 days after the preparation in terms of osmolarity, PH, MIC, the presence of contamination and subjectively were evaluated for the physical properties (color,free particle).
Results: There was no significant differences in MIC of Vancomycin within 4c at 14 days .Sterility was preserved for all 4 antibiotics at all tempreture out of 4 weeks.
Conclusion: Vancomycin eyedrops in BSS, DW5 can be safely used for 4 weeks. We recommended BSS, Sodium chloride for Amikacin and should de discard after 1weeks in 4 c ,24c . Cefazolin was recommended in DW5 and Sodium chloride and should de discard after 1weeks in 4 c ,24c .DW5 , sodium choloride was recommended for Ceftazidim and store in 4c was recommended. Snotears artificial tears wasnot recommended for any preparations.
KeyWord: Fortified ophthalmic antibiotic eye drop Stability, Bacterial keratitis , MIC , BSS , Dexterose5 , Snotears, NS 0/9

 

Purpose: To assess and compare preoperative refractive, aberrometric, topographic, and contrast sensitivity (CS) measurements with postoperative values after corneal collagen cross‑linking (CXL) in patients with progressive keratoconus.
Methods: Twenty‑two eyes of 11 patients with keratoconus were enrolled in this prospective study. Uncorrected distance visual acuity (UDVA), best spectacle corrected visual acuity (BSCVA), CS, and higher order aberrations (HOAs) were evaluated at baseline and 1, 3, 6, and 8 months after surgery.
Results: The mean total HOAs of the included patients were 2.24, 2.34, 2.28, 2.17, and 2.03 μm before and 1, 3, 6, and 8 months after CXL, respectively. A significant reduction in corneal HOAs including vertical coma, vertical and horizontal trefoil and spherical aberration was observed 6 and 8 months after CXL. UDVA and BSCVA improved significantly in all patients who completed the follow‑up period (P = 0.001). Although mean CS declined significantly 1 month postoperatively, it improved significantly after 3, 6, and 8 months (P<0.001). Maximum keratometry was significantly lower 8 months postoperatively compared to the preoperative value. (P = 0.006).
Conclusions: CXL seems to improve UCVA, BSCVA, and CS and reduce most corneal HOAs in progressive forms of keratoconus.
Keywords: Collagen Cross‑linking; Contrast Sensitivity; Corneal Aberration; Keratoconus

Introduction: To compare various accommodative parameters in prepresbyopic diabetic patients with age-matched healthy individuals.

Materials and Methods: Study population consisted of 32 younger-onset diabetic patients (30-40 years of age) and 28 age matched healthy normal individuals. Using the best correction for distance visual acuity (20.20 by Snellen chart), multiple accommodative ability tests such as near point of accommodation, accommodative amplitude, negative or positive accommodative facility and near point of convergence were measured in both groups.

Results: Mean near point of accommodation in diabetic patients was significantly greater than the control group (18.5±4.4 centimeters  versus 9.5±2 centimeters, p= 0.000). Mean accommodative amplitude was (5.93±1.75) Diopter (D) and (10.95±2.16) Diopter in diabetics and normal individuals, respectively (p=0.000). Mean accommodation facility was (3.19±3.04) cycle/minute in patients and 10.01±5.09 cycle/minute in the control group (p= 0.000). Mean positive relative accommodation was (–3.37±1.19) D in diabetic and (-2.11±0.99) D in healthy participants (p=0.000). Mean negative relative accommodation was lower in diabetic patients compared with the control group, however, this difference did not reach statistical significance (2.61±0.65) D versus (2.61±0.60) D, p= 0.23). Mean near point of convergence was (8.23±1.43) cm and (7.13±0.67) cm in normal and diabetic groups, respectively which had insignificant difference (p= 0.45).

Conclusion: Majority of accommodative ability functions decreased in Prepresbyopic diabetic patients. Early detection and rehabilitation of such patients with corrective near spectacles are strongly recommended.

Keywords: Accommodation Convergence Diabetic Pre-presbyopic

 

 

Method: This cross sectional study included 100 cases with severe non-Introduction: Advances in retinal imaging have allowed a better understanding of retinal vascular parameters and their relationship with pathophysiologic processes in and beyond the retina. This study was conducted to compare the retinal arterial bifurcation angles in sever non proliferative diabetic retinopathy (p<0.001). Second retinal arterial bifurcation angles were wider in severe NPDR patients, too. (p<0.001) But we didnt find any correlation between age, sex, hyperipidemia, blood pressure, HbA1C, diabetes duration and retinal arterial bifurcation angles.(p>0.05) Also, we showed that mean of first retinal arterial bifurcation angles in normal subject, not in sever NPDR patients, was close to theoretical optimal bifurcation angle.
Result: The mean age of participants was 45.96 proliferative diabetic retinopathy (NPDR) and 93 normal controls. The retinal arterial bifurcation angles were quantified for each subject by means of Adobe Photoshop CS5 software manually.
Conclusion: The existence of these differences gives us a potential use for this analysis method as novel criteria for development and progression of diabetic retinopathy.
Keywords: arterial branching angle, diabetic retinopathy. -8.15 years. The mean of first retinal arterial bifurcation angles was significantly higher in patients with sever non

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Introduction:Photo‬ ‭retinography findings.
Method: 40 photochemotherapy candidates were selected according to the inclusion and exclusion criteria, and their demographic information, disease characteristics, other treatment modalities and the routine lab examinations, were recorded. Enrolled patients were referred for ophthalmologic examination including standard electro-chemoterapy, disputed this belief and disclosed the necessity of close electro-retinographic patterns in 2 patients undergoing photo-chemoterapy is one of the common therapeutic methods in cutaneous diseases. It's been believed that because of high absorbance capability of anterior eye components this method doesnt affect deeper structures such as retina.  
Results: 24 female and 16 male patients (mean age of 32.05-version4.3.8 machine) funduscopic examinations which were repeated after 6 months of photochemotherapy. Finally, the collected data were statistically analyzed using SPSS 11.5 and t-retinography (using RETIport32-retinographic assessments for potential complications of photochemotherapy on the retina.
Conclusion: A 6-retinographical phases showed a significant difference in some waves between the two groups. 20 patients attended for the second ophthalmologic examination after 6 months. In comparison between pre and post treatment electro-1.21 years) were included. Underlying skin disease was psoriasis in15 patients, vitilligo in 23, and eczema in 2. In baseline examinatioin, electro‬ -retinographic changes but underlying diseases may be of importance in electro-month course of phototherapy doesnt seem to cause electro-retinographic waves no significant difference was found .
Keywords: photochemotherapy, methoxsalen, Ultra violet A, electrophysiology, electroretinography.

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‭Purpose: To evaluate changes in corneal topography and biomechanical properties after collagen cross-linking (CXL) for progressive keratoconus.

Keywords: Biomechanics; Collagen Crosslinking; Corneal; Keratoconus; Specular Microscopy; Topography.

‭Objective:Evaluation of the outcome of silicone oil removal, retinal redetachment rate, visual acuity, and complications in eyes that have undergone pars plana vitrectomy with silicone oil injection for treatment of advanced proliferative diabetic retinopathy (PDR). 
Method: Retrospective study of eyes that have undergone pars plana vitrectomy and silicone injection and later silicone oil removal. Changes in visual acuity, recurrent retinal detachment, and incidence of complications are reported. 
Results: The minimum follow ‭up period was 1 months. Retinal redetachment ocurred in 15 eyes (25.9 ). 42 eyes underwent cataract surgery at the time of silicone oil removal. The mean duration of intraocular silicone oil tamponade was 8.3 months, with a mean postoperative follow up of 19 month. Mean intra ocular pressure was 13.9 mmHg. There was no significant difference between intra ocular pressure before and after silicone oil removal. (P=0.059.) There were 7 patient(12.1 ) with V/A more than 1/10 before vitrectomy and 16 patients (29.6 ) after silicone oil removal. 76.4 patients had visual improvement after silicone oils removal. Glaucoma was seen in 12 eyes (21.8 ) after silicone oil removal but there were no glaucoma cases before silicone oil injection.‬
Conclusion: Removal of silicone oil improved visual acuity. One in four eyes with advance PDR who had undergone pars plana vitrectomy and silicone oil injection are at risk of redetachment after removal of the oil in spite of complete pan retinal photocoagulation. The duration of the silicone oil tamponade had no significant effect on the reattachment rate.

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‭Background: Multiple surgical interventions are burden to patients with intermittent exotropia (IXT) due to a high recurrence rate. This study was designed to evaluate the efficacy of botulinum toxin injection in the treatment of intermittent exotropia (IXT).
Method: A total of 21 patients with IXT, who had a far deviation of less than 40 prism diopters (PD), were enrolled. All cases were followed for at least 6 months with non-surgical management and had decremented fusional control (increasing 3 or more scores in Newcastle Control Score (NCS)). Botulinum toxin was injected (10 units Dysport) to both lateral rectus muscles. Fusional control, sensory and motor status were evaluated at 1 day, 1 week, and 1, 3, and 6 months after injection to compare with the pre-injection values.
Results: Fusional control (based on NCS) showed a significant improvement during 6-month follow-up. Mean NCS was 4.4±0.8 SD before botulinum toxin injection and 1.4±0.4 SD after 6 months (p<0.001). Evaluation of sensorial status with Worth Four Dot Test (WFDT) also demonstrated an improvement of fusion (the percentage of patients demonstrating fusion on WFDT were 10.5% before injection and 61.5% after 6 months). The mean far and near deviations decreased during 6 months of follow-up examination. Satisfactory outcome (stable binocular alignment of the eyes to an orthophoria+/-10 PD in primary position) for far distance was achieved in 38.1% at 6 months. The percentage of satisfactory outcome at near was 86% at 6 months follow-up examination. Conclusion: Botulinum toxin injection to lateral rectus muscles seems to be a promising procedure in the management of fusional control, far and near deviations in patients with intermittent exotropia in short time.

‭Background: Topical anesthesia is a safe and cost-effective method considered as the first-choice in many procedures. Due to the physiological characteristics of eye, most of the local anesthetics cannot efficiently penetrate through the conjunctiva deep to tenon. The aim of this pilot study was to find a new form of
lidocaine to give a sufficient level of anesthesia.
Methods: Lidocaine Cyclodextrin complex ophthalmic drop was produced and its pharmacological properties were studied (tested) in standard temperature and pressure. 30 patients (18 males, 12 females) with the mean age of 30.68±8.02 years enrolled in this clinical trial. All the patients were fully informed and signed the ethics committee consent forms. The patients were given tetracaine drop as the anesthetic: 3 drops separated 2 minute apart 10 min before the intervention. If we achieved a sufficient level of anesthesia, the procedure was done after. If the patient could not tolerate the procedure, the method was changed to lidocaine drop (administered after wash-out period like the first drop).The last option was conventional injection method if the patient could not tolerate the procedure with the second method either.We used this type of anesthesia for conventional procedures such as forced duction test, symblepharon, pterygium, and disport injection into extra-ocular muscles. All the procedures were done by one surgeon in a university hospital. We used a 0 to 10 visual analogue scale for pain and two 0 to 4 patient and physician satisfaction scales designed for this study.
Results: The mean pain score was 7.53±0.90 in group 1 and 3.03±1.83 in group 2 (P=0.00). Patient and surgeon satisfaction in group 1 were 1.33±0.48 and 1.40±0.56 respectively; while 3.23±1.00 and 3.56±0.77 for group 2 (P=0.00). Tetracaine drop could not induce sufficient anesthesia for none of the patients. Cyclodextrin based lidocaine drop was successful except For two patients for whom we changed the anesthesia to Sub-conjunctival injection method.
Conclusion: Our newly manufactured cyclodextrin based lidocaine eye drop could successfully induce sufficient anesthesia for 28 of 30 patients. Further studies with larger sample sizes are now being designed to find more clinical evidence about this method.
Keywords: Drug Delivery, Lidocaine, Cyclodextrin, Ophthalmic drop, Pterygium, Symblepharon, Dysport

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Background: Eyelid and conjnctival malignancies are completely treatable if detected early.The treatment depends on the invasiveness of the tumor and the type of malignancy.the aims of this study were to characterize the distribution of the types of eyelid and conjnctival lesions and determine the accuracy and sensivity of the clinical diagnosis of them by ophthalmologists in Mashad university hospital.
Methods: between 1998 and 2008, 1028 patient with histologically confirmed eyelid and conjunctival lesions were retrospectively evaluated at Mashad university hospital.clinical data of all patients were reviewed from medical records.
Results: of the 1028 spicimens,741 cases were eyelid spicimens and 278 cases were conjunctival spicimens.The most common bening lesions of eyelid and conjunctival were melanocytic nevi, .The most common malignant and pre‬ malignant lesions of eyelid were basal cell carcinoma and actinic keratosis and of the conjunctival was squamous cell carcinoma and sever dysplasia.The mean age was 48.5 years old.there was a significant gender predilection among the malignant tumours of lid to male.bening lesions were more frequent in upper lid wherase malignant lesions were more frequent in lower lid.conjunctival lesions were comon than in male to female.
Conclusions: At the Mashad university hospital between 1998 and 2008 the predominant malignant tumors of the eyelid were basal cell carcinoma and squamous cell carcinoma,and of the conjunctival were squamous cell carcinoma and malignant melanoma.The malignant lesions occurred predominantly in elderly patints.The sensivity of the clinical diagnosis of malignant Lid and conjunctival tumors were 90 .
Keywords: Eyelid disorders,conjunctival disorders,Eyelid tumors,conjunctival tumors.

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