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Aim and Design:A retrospective, nonrandomized, single-center clinical study was designed to evaluate the outcomes of corneal collagen crosslinking (CXL) for progressive keratoconus in Iranian patients 12 months after CXL.Settings:This study was carried out at Navid Didegan Eye Center, a private clinic, Mashhad, Iran.Materials and Methods:Ninety-two eyes of 53 subjects with progressive keratoconus were evaluated in this study. All eyes completed 1-year follow-up. The outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), sphere and cylinder refraction, keratometry, and corneal thickness. Comparison of baseline and 1-year postoperative data is reported in this study. The Wilcoxon signed-ranked and Student’s t-tests were used for statistical analyses. P < 0.05 was statistically significant.Results:The mean age was 21.5 ± 3.4 years (range, 16 -30 years). Thirty-one (58.5%) of the subjects were men and 22 (41.5%) were women. Mean baseline UCVA and BSCVA were 0.61 ± 0.31 and 0.06 ± 0.12 logarithm of minimal angle of resolution (logMAR), respectively. One year postoperatively UCVA was 0.31 ± 0.25 logMAR and BSCVA was 0.0 ± 0.01 logMAR. UCVA and BSCVA were statistically higher postoperatively (P < 0.001, both parameters). The mean astigmatism decreased by 0.78 ± 1.49 diopter (D) with significant variation during the follow-up period (P < 0.001). Mean baseline simulated keratometry (SIM K) was 46.94 ± 2.37 D and decreased to 46.0 ± 2.33 D on year postoperatively (P < 0.001).Conclusion:Corneal CXL seems to be efficient in stabilization of progressive keratoconus progression in Iranian patients at 1 year of followup.

Background:Keratoconus is a contraindication for photorefractive keratectomy (PRK). In the recent decade, some efforts have been made to perform PRK in patients with keratoconus whose corneas are stable naturally or by doing corneal collagen crosslinking. These studies have suggested residual central corneal thickness (CCT) ≥450 μm.Aims:The aim was to evaluate the long-term outcomes of PRK in patients with mild to moderate keratoconus in patients older than 40 with residual CCT ≥ 400 μm.Settings and Design:This prospective study was conducted in our Cornea Research Center, Mashhad, Iran.Materials and Methods:Patients over 40 years old, with a grade I/II keratoconus without progression in the last 2 years were recruited. Patients with a predicted postoperative CCT < 400 μm were excluded. PRK with tissue saving protocol was performed with Tecnolas 217 Z. Mitomycin-C was applied after ablation. The final endpoints were refraction parameters the last follow-up visit (mean: 35 months). Paired t-test and Chi-square were used for analysis.Results:A total of 38 eyes of 21 patients were studied; 20 eyes (52.6%) with a grade I and 18 eyes (47.4%) with grade II keratoconus. The mean uncorrected visual acuity, best corrected visual acuity (BCVA), spherical equivalent, cylindrical power and keratometric readings were significantly improved at the final endpoint compared to preoperation measurements (P < 0.001). Two eyes (5%) lost two lines of BCVA at the final visit. No case of ectasia occurred during the follow-up course.Conclusions:PRK did not induce keratoconus progression in patients older than 40 with a grade I/II keratoconus. Residual CCT ≥ 450 μm seems to be sufficient to prevent the ectasia.

Superficial keratectomy with MMC and EWCLs is effective in reducing persistent and refractory corneal haze after PRK.

A 16-year-old female with juvenile idiopathic arthritis presented with a one-month history of decreasing vision and increasing corneal edema in her left eye. Slit-lamp examination, keratometric measurements, and OCT evaluation led to a diagnosis of Terrien's marginal degeneration in both eyes along with a complete detachment of Descemet's membrane in the left eye and partial detachment in the right eye. She was treated with an intracameral injection of air and then topical betamethasone and chloramphenicol which lead to the resolution of symptoms. We further examine the pathophysiology of this disease based on current literature.

Foodborne botulism is a serious condition caused by Clostridium botulinum neurotoxin. Clinically, botulism presents as bilateral cranial nerve neuropathy and descending paralysis. We report a unique presentation of botulism to remind clinicians of this potentially fatal condition. In this observational case report initial evaluation showed only esodeviation. This progressed to unilateral cranial nerve six (CN VI) paresis along with systemic signs. Clinical diagnosis was made based on in-depth history and concurrent symptoms in three other patients. Foodborne botulism presenting as diplopia and unilateral motility deficits is rare and can represent a diagnostic and therapeutic challenge to the ophthalmologist.

PurposeTo explore utilization of the coaxially sighted corneal light reflex (CSCLR) for centration during myopic photorefractive keratectomy (PRK) for patients with relatively high angle kappa (κ) values.MethodsPatients were stratified into two groups preoperatively, on the basis of angle κ values.Group A was composed of 166 eyes with an angle κ value <5°. Group B consisted of 182 eyes with an angle κ value >5°. Intraoperative centering of ablation was performed within group A by utilizing the pupillary center, and within group B by using the CSCLR. Visual acuities were evaluated and compared at 6 months and 12 months postoperatively between groups.ResultsMean uncorrected visual acuities (UCVA) for all patients at 6 months and 12 months were −0.073 logMAR and −0.080 logMAR, respectively. A total of 98.9% of patients had a UCVA of 0.00 logMAR (≈20/20 Snellen) 12 months postoperatively. There was not a significant between-group difference in regard to residual refractive error at 6 months or 12 months (P=0.53 and P=0.97), or in UCVA at 6 months and 12 months (P=0.76 and P=0.17). There were no subjective complaints of monocular diplopia, glare, or haloes within either group at any time during follow-up.ConclusionAvailing use of the CSCLR for centration of ablation within myopic patients with high angle κ values may aid in providing better refractive outcomes after performance of PRK.