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Kangari H.,Shahid Beheshti University of Medical Sciences | Eftekhari M.H.,Shahid Beheshti University of Medical Sciences | Sardari S.,Shahid Beheshti University of Medical Sciences | Hashemi H.,Noor Ophthalmology Research Center | And 3 more authors.
Ophthalmology | Year: 2013

Purpose: To assess the effect of oral omega-3 fatty acids on tear break-up time (TBUT), Schirmer's score, and Ocular Surface Disease Index (OSDI) through a double-blind clinical trial. Design: Randomized, double-blind clinical trial. Participants: Sixty-four patients with dry eye symptoms between the ages of 45 and 90 years were randomized into 2 groups: 33 persons in the treatment group and 31 persons in the placebo group. Methods: The treatment group received 2 capsules of omega-3 (each containing 180 mg eicosapentaenoic acid [EPA] and 120 mg docosahexaenoic acid [DHA]) daily for 30 days, and the placebo group received 2 medium-chain triglyceride oil capsules daily for 1 month. The outcomes were measured 1 month after the intervention. Main Outcome Measures: The primary outcome measure was an increase from baseline in TBUT at day 30. Secondary outcome measures were a decrease from baseline in the OSDI score and an increase in the Schirmer's score at day 30. Results: In the placebo group, before the intervention, the mean TBUT, OSDI, and Schirmer's scores were 4.5 ± 2.1 seconds, 36.4 ± 13.8, and 6.0 ± 2.6 mm, respectively, and 1 month later were 4.7 ± 2.6 seconds, 37.6 ± 13.5, and 6.2 ± 2.5 mm, respectively. In the treatment group, these values were 3.9 ± 1.7 seconds, 38.7 ± 16.5, and 5.8 ± 2.5 mm before the intervention and 5.67 ± 2.6 seconds, 29.3 ± 15.9, and 6.8 ± 2.8 mm after the intervention, respectively. Repeated-measures analysis of variance showed that improvements in TBUT, OSDI, and Schirmer's scores were significantly better in the treatment group than in the placebo group. The changes in the treatment and placebo groups were 71% and 3.3% for TBUT (P < 0.001), 26% and 4% (P=0.004) for dry eye symptoms, and 22.3% and 5.1% for Schirmer's score (P=0.033), respectively. Conclusions: This study demonstrated that oral consumption of omega-3 fatty acids (180 mg EPA and 120 mg DHA twice daily for 30 days) is associated with a decrease in the rate of tear evaporation, an improvement in dry eye symptoms, and an increase in tear secretion. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2013 by the American Academy of Ophthalmology. Source

Hashemi H.,Noor Ophthalmology Research Center | Yekta A.,Mashhad University of Medical Sciences | Khabazkhoob M.,Shahid Beheshti University of Medical Sciences
Journal of Cataract and Refractive Surgery | Year: 2015

Purpose To determine the repeatability of keratometry (K) measurements of a Scheimpflug pachymeter (Pentacam), Placido topographer (Eyesys), scanning-slit corneal topographer (Orbscan), partial coherence interferometry (PCI) device (IOLMaster), and Javal manual keratometer with different grades of keratoconus. Setting Noor Eye Hospital, Tehran, Iran. Design Retrospective case series. Methods Keratometry was performed first with Scheimpflug pachymetry followed, in order, by Placido topography, scanning-slit corneal topography, PCI, and manual keratometry. Repeatability was examined in groups with a maximum K of less than 50.0 diopters (D), 50.0 to 55.0 D, and more than 55.0 D. Results Seventy-eight eyes of 45 keratoconus patients were assessed. In Group 1, repeatability was highest with Scheimpflug pachymetry and lowest with scanning-slit corneal topography (0.36 to 1.24). In Group 2, the intraclass correlation coefficients (ICCs) for maximum K ranged from 0.823 with the scanning-slit corneal topography to 0.974 with Scheimpflug pachymetry. The repeatability index for minimum K (0.53 to 2.11) and maximum K (0.60 to 1.92) in this group was highest with Scheimpflug pachymetry and with for scanning-slit corneal topography. In Group 3, the ICCs for minimum K and maximum K ranged from 0.890 to 0.990, and the repeatability index for minimum K varied between 1.66 with Scheimpflug pachymetry to 2.98 with Placido topography; for maximum K, the index was from 2.15 with PCI to 2.81 with the manual keratometer. Conclusions In mild keratoconus, the 5 devices had acceptable repeatability in K readings. In cases with a maximum K reading greater than 55.0 D, all devices had reduced repeatability as a result of measurement errors; thus, measurements might not be so reliable. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. © 2015 ASCRS and ESCRS. Source

Hashemi H.,Noor Ophthalmology Research Center | Dadgostar A.,Tehran University of Medical Sciences
Cornea | Year: 2011

Purpose: To assess the visual outcome of using fibrin adhesive in automated lamellar therapeutic keratoplasty with a microkeratome in the treatment of anterior corneal opacities. Methods: In this prospective noncomparative clinical trial, surgery was done on 10 eyes belonging to 9 patients with anterior stromal opacity (macular dystrophy, spheroidal degeneration, scarring because of advanced recurrent pterygium, refractive surgery, or trauma). Depending on the depth of the opacity, a 130-or 250-μm flap was removed from the recipient cornea using a microkeratome. Then, a thin layer of fibrin adhesive was spread over the bed, and a lenticule with the same thickness, created from the donor cornea, was positioned in place. After allowing the glue to set for about 5 minutes, a bandage contact lens was placed over the cornea, which was removed 7-10 days postoperatively. Results: All corneas healed properly, and none required suturing or reoperation. During the follow-up period, no inflammation or rejection was observed. The donor cornea and the donor-recipient interface remained clear in all cases. The mean of best contact lens-corrected visual acuity improved from 1.14 ± 0.53 to 0.51 ± 0.23 in the logarithm of the minimum angle of resolution scale. Conclusions: The fibrin glue can provide safe and effective attachment needed in automated lamellar therapeutic keratectomy and obviates the need for suturing. However, it requires improvement for easier and safer use in ophthalmology. Copyright © 2011 by Lippincott Williams & Wilkins. Source

Koucheki B.,Noor Ophthalmology Research Center | Hashemi H.,Noor Ophthalmology Research Center | Hashemi H.,Tehran University of Medical Sciences
Journal of Glaucoma | Year: 2012

Purpose: To determine the effect of selective laser trabeculoplasty (SLT) on different types of open-angle glaucoma (OAG) in terms of intraocular pressure (IOP). Methods and Materials: In this prospective, nonrandomized, interventional study, patients with OAG, unresponsive to maximum tolerable antiglaucoma medication, were enrolled. One thirty six eyes were studied. Distribution of glaucoma type was 91 primary OAG eyes (POAG, 66.9%), 22 pseudoexfoliative glaucoma (PEX, 16.2%) eyes, and 23 pigmentary glaucoma (PG, 16.9%) eyes. Main outcome measures were IOP and number of antiglaucoma medications used before operation, at 1 day, at 1 week, and at 1 to 18 months after surgery. Using the standard approach 360-degree SLT was done. RESULTS: The mean follow-up was 16.6±4.3 months. The mean preoperative IOP was 22.0±3.7 mm Hg, and reduced to 18.3±3.7 mm Hg at last visit. The overall mean IOP decrease was 3.6±2.6 mm Hg (16.3%) on the last visit compared with before surgery, indicating a reduction of 16.7% in POAG, 16.6% in PEX, and 14.5% in PG. Comparison of IOP values at 6 and 16 months showed an increase of 0.5 and 2.7 mm Hg in total sample and PG group. IOP reduction was significantly less among diabetic patients. Conclusions: SLT resulted in a significant IOP reduction of 16.3% at 16 months after surgery. The level of IOP reduction did not vary in POAG, PEX, and PG groups. A significant increase in IOP was observed in PG group after 6 months. The procedure seemed least effective in diabetic patients. © 2012 by Lippincott Williams & Wilkins. Source

Hashemi H.,Noor Ophthalmology Research Center | Seyedian M.A.,Noor Ophthalmology Research Center | Miraftab M.,Noor Ophthalmology Research Center | Fotouhi A.,Tehran University of Medical Sciences | Asgari S.,Noor Ophthalmology Research Center
Ophthalmology | Year: 2013

Purpose: To evaluate the long-term results of corneal collagen cross-linking (CXL) in patients with progressive keratoconus. Design: Prospective case series. Participants: This study was conducted on 40 eyes of 32 patients with progressive keratoconus between 2006 and 2012. Methods: Patients underwent CXL no later than 1 month after baseline examinations. For CXL, ultraviolet irradiation was applied for 30 minutes, during which riboflavin instillation was repeated every 3 minutes. Main Outcome Measures: Patients were tested for best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), manifest refraction spherical equivalent (MRSE), and Scheimpflug imaging from which we extracted maximum keratometry reading (max-K), average of minimum and maximum keratometry readings (mean-K), central corneal thickness (CCT), and anterior and posterior elevation at the apex at baseline, at 1, 3, 6 months after CXL, and 1, 2, 4, and 5 years later. We studied results at 5 years after CXL as well as the trend of changes over the 5-year period. Results: Mean UCVA was 0.67±0.52 logarithm of the minimum angle of resolution (logMAR) at baseline and 0.65±0.51 logMAR at 5 years after the procedure. For mean BCVA, these values were 0.31±0.28 and 0.19±0.20 logMAR, respectively (P = 0.016). The mean MRSE changed from -3.18±2.23 diopters (D) to -2.77±2.18 D, and mean refractive cylinder error changed from -3.14±2.22 to -2.49±1.71 D (P = 0.089). Mean max-K and mean-K decreased by 0.16±2.20 and 0.10±1.69 D, respectively. The CCT increased from 483.87±29.07 to 485.95±28.43 μm. Mean anterior elevation at the apex changed from 13.9 2±8.28 to 11.45±8.18 μm (P = 0.030) and posterior elevation at this point changed from 29.54±18.39 to 26.34±19.59 μm. The mean-K, max-K, UCVA, and astigmatism showed no change over time during these 5 years. After the first year, BCVA, MRSE, and CCT showed no change and stabilized, whereas elevation readings continued to decrease up to 5 years after CXL. Conclusions: Based on our 5-year results, treatment of progressive keratoconus with CXL can stop disease progression, without raising any concern for safety, and can eliminate the need for keratoplasty. © 2013 by the American Academy of Ophthalmology Published by Elsevier Inc. Source

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