Background: The sacroiliac joint dysfunction (SIJD) has been found to be the primary culprit for lower back pain (LBP), but it is still overlooked and treated as LBP. There are no guidelines or appropriate therapeutic protocols for SIJD. Thus, there is a need for an effective treatment strategy for SIJD. Objective: To compare exercise therapy (ET), manipulation therapy (MT), and a combination of the 2 (EMT) in terms of their effectiveness in treating SIJD. Study Design: A comparative, prospective, single-blind randomized controlled trial . Setting: Sports Medicine Department of Rasoul Akram Hospital. Methods: A total of 51 patients with lower back or buttock pain resulting from SIJD were randomly assigned to 1 of 3 study groups: ET, MT, or EMT. The ET group received posterior innominate self-mobilization, sacroiliac joint stretching, and spinal stabilization exercises. The MT group underwent posterior innominate mobilization and SIJ manipulation. Lastly, the EMT group received manipulation maneuvers followed by exercise therapy. Pain and disability were assessed at 6, 12, and 24 weeks after the interventions. Results: All 3 groups demonstrated significant improvement in pain and disability scores compared to the baseline (P < 0.05). The difference among these therapeutic protocols was found to be a function of time. At week 6, MT showed notable results, but at week 12, the effect of ET was remarkable. Finally, at week 24, no significant difference was observed among the study groups. Limitations: A major limitation of the present study is lack of a control group receiving a type of intervention other than the experimental protocols. Another limitation is the short duration of follow-ups. Conclusions: Exercise and manipulation therapy appear to be effective in reducing pain and disability in patients with SIJD. However, the combination of these 2 therapies does not seem to bring about significantly better therapeutic results than either approach implemented separately. Key words: Exercise therapy, manipulation therapy, sacroiliac joint dysfunction

Objective: The aim of this study was to evaluate the effects of goniotomy on patients with primary angle-closure glaucoma who underwent “phacoemulsification and visco-goniosynechialysis.” Materials and methods: This prospective randomized clinical trial was carried out on 63 eyes of 61 patients (48–85 years) with primary angle-closure glaucoma who were enrolled. The subjects were randomly assigned into two groups. In the first group (32 eyes) and the second group (31 eyes), the patients underwent “phacoemulsification + visco-goniosynechialysis + goniotomy” and “phacoemulsification + visco-goniosynechialysis,” respectively. Intraocular pressure and antiglaucoma medication were evaluated (1 week, as well as 1, 3, and 6 months after the surgery). Anterior segment optical coherence tomography parameters (Casia, Tomey, USA) and goniotomy were evaluated preoperatively and 6 months after the surgery. Results: The mean intraocular pressure lowering the effects in the “phacoemulsification + visco-goniosynechialysis + goniotomy” group was higher than that in the “phacoemulsification + visco-goniosynechialysis” group (6.93 and 4.6, respectively). Furthermore, the difference in intraocular pressure between the two groups was significant at 3 months (P = 0.014) and 6 months (P = 0.021) after the surgery. There was no difference in anterior segment optical coherence tomography findings before the intervention; however, after the intervention, the anterior segment optical coherence tomography indices were significantly different between the two groups. Moreover, the difference in “phacoemulsification + visco-goniosynechialysis + goniotomy” indices was more than the changes in the “phacoemulsification + visco-goniosynechialysis” group. Conclusion: The results of this study showed that phacoemulsification + visco-goniosynechialysis + goniotomy is a more effective surgery than phacoemulsification + visco-goniosynechialysis alone in undercounted primary angle-closure glaucoma.

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PurposeTo evaluate the effect of MyoRing implantation on corneal asphericity in moderate and severe keratoconus (KCN).MethodsThis cross-sectional observational study comprised 32 eyes of 28 patients with KCN, who had femtosecond-assisted MyoRing corneal implantation. The primary outcome measures were preoperative and six-month postoperative corneal asphericity in 6-, 7-, 8-, 9-, and 10-mm optical zones in the superior, inferior, nasal, temporal, and central areas. The secondary outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, thinnest location value, and keratometry readings.ResultsA significant improvement in the UDVA and CDVA was observed six months after the surgery (P < 0.001) with a significant reduction in the spherical (4.67 diopters (D)) and cylindrical (2.19 D) refractive errors. A significant reduction in the corneal asphericity in all the optical zones and in the superior, inferior, nasal, temporal, and central areas was noted (P < 0.001). The mean thickness at the thinnest location of the cornea decreased from 437.15 ± 30.69 to 422.81 ± 36.91 μm. A significant corneal flattening was seen. The K1, K2, and Km changes were 5.32 D, 7 D, and 6.17 D, respectively (P < 0.001).ConclusionMyoRing implantation is effective for improving corneal asphericity in patients with KCN. It allows successful corneal remodeling and provides a significant improvement in UDVA, CDVA, and refractive errors.

A child with Winchester syndrome, studied in Iran, is the sixth reported case in the literature. The cutaneous manifestations of this syndrome include leathery thickening of the skin, hyperpigmentation and hypertrichosis. The lips and gingiva are hypertrophic. There are also arthritic changes involving the small joints.

We used anterior segment optical coherence tomography to investigate anterior chamber angle in primary angle-closure glaucoma (PACG) eyes following phacoemulsification and phacotrabeculectomy. Angle widening was significantly greater after phacoemulsification up to 6 months after the surgery.Purpose: To compare anterior chamber angle following 2 common surgeries for PACG.Methods: One hundred ten glaucoma patients were evaluated in this single center, prospective, randomized clinical trial. Those with concomitant PACG and senile cataract and without a history of ocular surgery, trauma, or chronic miotic use were recruited. Monocular patients were also excluded. Finally, 52 eligible subjects were randomly assigned to phacoemulsification ("Phaco" group, 25 eyes) or phacotrabeculectomy ("Combined" group, 27 eyes) surgeries. A swept-source, anterior segment optical coherence tomography device (CASIA SS-1000 OCT) was used to image the anterior segment. Mask graders used the images to measure the following parameters before and 1 week, 1 month, and 6 months after surgery: angle opening distance at 500 µm, trabecular iris surface area at 500 µm, and trabecular iris angle at 500 µm.Results: There was no significant difference between study groups regarding best-corrected visual acuity, intraocular pressure (IOP), and the number of glaucoma medications in preoperative or postoperative visits (P > 0.076). Also, the measured angle parameters were not statistically significantly different between the 2 groups before surgery (P > 0.123). After surgery, all measured parameters were significantly increased in both groups (P < 0.0001). At the 6-month follow-up, nasal angle opening distance at 500 µm was 0.383 ± 0.027 vs. 0.349 ± 0.017, trabecular iris surface area at 500 µm was 0.141 ± 0.007 vs. 0.125 ± 0.005, and trabecular iris angle at 500 µm was 40.1 ± 12.9 vs. 34.6 ± 3.1 in Phaco and Combined groups, respectively (P < 0.0001 for all).Conclusions: Anterior chamber angle widening by anterior segment optical coherence tomography was observed in PACG patients following surgery and was significantly greater after phacoemulsification compared with combined phacotrabeculectomy at all time points. Similar IOP and medication burden were noted for up to 6 months as secondary outcomes. The contribution of angle changes to the IOP-lowering effect of phacoemulsification in PACG eyes needs further study.

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