Medical hypothesis discovery and innovation in ophthalmology

Editorial/No abstract

Epidemic keratoconjunctivitis (EKC), caused by certain species D human adenoviruses (Ads), is a highly contagious severe disease involving both the conjunctiva and cornea. The hallmark of this disease is the subepithelial infiltration of leukocytes, which results in corneal opacities that may persist for months or even years. In this case, of a 6-month-old infant, we report a symblepharon formation, a relatively rare outcome of EKC. In this condition, the palpebral conjunctiva adheres tightly to the bulbar conjunctiva of the eyeball. Our report is the first documentation of a symblepharon formation in an infant. Only two similar cases have been reported to date; therefore, a detailed description is of considerable interest to ophthalmologists. This is particularly interesting since a previous publication has associated symblepharon formation with an adenovirus infection, which is not usually involved in EKC. The development of a symblepharon following EKC is rare in infants. Since topical treatment cannot be applied due to severe eyelid edema, oral steroid therapy can be administered with pediatric consultation and meticulous monitoring. 

Atropine has been used for more than a century to arrest myopia progression. Compelling evidence of its protective effect has been reported in well-designed clinical studies, mainly performed during the last two decades. However, its exact mechanism of action has not been determined. Experimental findings have shown that the mechanism is not related to accommodation, as was thought for decades. A review of the published literature revealed a significant amount of evidence supporting its safety and efficacy at a concentration of 1.0%, and at lower concentrations (as low as 0.01%).

The aim of this study was to evaluate the effect of the mechanical implantation of a MyoRing in patients with severe keratoconus and high myopia. The study involved 32 eyes of 32 patients (14 men and 18 women; mean age: 29.6 ± 6.7; age range: 20 – 44). The patients underwent MyoRing implantation with mechanical dissection using a Pocket Maker microkeratome, and outcomes were assessedat3 months after surgery. The main outcome measures were uncorrected and corrected distance visual acuity (UDVA and CDVA, both in Logarithm of the Minimum Angle of Resolution [logMAR] units), manifest refraction, and keratometry readings. There was a significant improvement in the UDVA, from 1.14 ± 0.32 to 0.35 ± 0.24 (P ˂ 0.001), and in the CDVA, from 0.47 ± 0.20 to 0.22 ± 0.15 (P ˂ 0.001). There was also a significant improvement in the spherical equivalent refractive error (-10.51 ± 2.81 D to -1.32 ± 2.29 D) (P ˂ 0.001). There was a significant decrease of manifest refraction in the mean sphere and cylinder of 7.70 and 2.6 D, respectively (P < 0.001). Furthermore, with regard to corneal topography, there was a significant reduction of 3.55 D (P ˂ 0.001) in the mean keratometry reading. The results show that the mechanical implantation of a MyoRing is effective for the correction of myopia in patients with keratoconus and high myopia. 

Our goal was to identify and describe factors relating to quality of life (QOL) in subjects with low vision and blindness in Iran's Sistan and Baluchestan Province. This cross-sectional study was carried out in randomly selected subjects with vision disability who were covered by the Zahedan Welfare Organization in Zahedan, Iran. The following factors related to visual impairment were evaluated: visual field (VF), visual acuity (VA), and stereopsis. Data were collected using a demographic questionnaire and the Influence of Vision Impairment (IVI) questionnaire. One-hundred and twenty-one patients were enrolled for participation in the study. T-test analyses indicated that the mean QOL score for women was significantly lower than that for men (P < 0.001). Mann-Whitney U tests indicated that mean social (P = 0.003) and leisure (P = 0.009) QOL scores were significantly lower in participants without stereopsis. In addition, participants with tunnel vision scored lower on the mobility and self-care categories (P < 0.001) than others. The results of this study indicate that providing education, providing employment, improving, and expanding social programs for the blind and individuals with low vision people, especially women, are necessary. 

We aimed to determine normal macular thickness using Cirrus high definition optical coherence tomography. In this cross-sectional survey, 112 subjects were selected using random sampling from the Rasht telephone directory. All subjects underwent complete eye examinations. Both eyes of each patient were evaluated. The creation of a macular thickness map using a macular cube 512 × 128 combo was optional. The average thickness of the retina was determined in 9 Early Treatment Diabetic Retinopathy Study (ETDRS) regions. To assess reproducibility and system reliability, the thickness of the retina was measured up to 5 times in 10 healthy subjects. The coefficient of variation was then calculated for each individual. The coefficient of variation of macular thickness within 1 mm of the center was 0.15 - 1.33%. The means and standard deviations of central subfield thickness (CST), macular thickness (MT), and macular volume (MV) were 245.44 ± 20.39 µm, 277.9 ± 12.0 µm, and 9.98 ± 0.43 mm3, respectively. The mean CST (P < 0.0001), MT (P = 0.038), and MV (P = 0.030) were significantly higher in men than in women. In addition, regardless of age or sex, macular thickness increased when moving from within 1 mm of the center to 3 mm and 6 mm away from the center, so that the upper 3 mm (S3) was the thickest region, and the temporal 6 mm (T6) was the thinnest region in the ETDRS regions. The mean MT of healthy subjects was 280.67 ± 12.79 µm in men and 276.63 ± 11.61 µm in women. Therefore, the macula is significantly thicker in men than in women (P = 0.038).