Purpose: To review current non-surgical management methods of intermittent exotropia (IXT) which is one of the most common types of childhood-onset exotropia. Methods: A search strategy was developed using a combination of the words IXT, divergence excess, non-surgical management, observation, overcorrecting minus lens therapy, patch/occlusion therapy, orthoptics/binocular vision therapy, and prism therapy to identify all articles in four electronic databases (PubMed, Web of Science, Google Scholar, and Scopus). To find more articles and to ensure that the databases were thoroughly searched, the reference lists of the selected articles were also reviewed from inception to June 2018 with no restrictions and filters. Results: IXT is treated when binocular vision is impaired, or the patient is symptomatic. There are different surgical and non-surgical management strategies. Non-surgical treatment of IXT includes patch therapy, prism therapy, orthoptic sessions, and overcorrecting minus lens therapy. The objective of these treatments is to reduce the symptoms and the frequency of manifest deviation by decreasing the angle of deviation or enhancing the ability to control it. Conclusions: Evidence of the efficacy of non-surgical management options for IXT is not compelling. More comprehensive randomized controlled trial studies are required to evaluate the effectiveness of these procedures and detect the most effective strategy.

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Purpose: To discuss the ocular manifestations provoked by novel coronavirus 2019 (COVID-19) disease in humans, the natural history of the disease in the eye, and its treatment. Methods: We designed a narrative review of the ocular manifestations of COVID-19 based on the literature published till July 30, 2020. The databases were PubMed, Scopus, Cochrane Library, Google Scholar, and ScienceDirect. The inclusion criteria were (1) all types of clinical studies and (2) the topic was COVID-19 and its association to the eye regarding the current guidelines. Results: From 168 abstracts screened, 61 papers fully filled the inclusion criteria after the full-text screening. The 61 records include 13 case reports, 17 prospective (case series or cross-sectional) studies, 8 retrospective studies, 12 literature reviews (one systematic review), and 11 letters to the editor. The majority of the papers agreed that ophthalmic manifestations due to COVID-19 were few and rarely encountered. The main ocular pathology seemed to be conjunctivitis, where the viral polymerase chain reaction also happened to be most detectable. Posterior segment or neuro-ophthalmic manifestations were scarce. Viral genome detection in the eye as well as viral portal of entry to the globe is still vague. Conclusion: The exact incidence of ocular manifestations in COVID-19 disease is uncertain. Conjunctivitis is the most prevalent ocular manifestation. It is still a debate whether the eye is a portal of entry for infection.

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Purpose: To identify and explain different artifacts in macular optical coherence tomography (OCT). Methods: For this comprehensive review, a PubMed and Google Scholar (January 1995–October 2018) search was conducted by the researchers, using the keywords such as OCT, artifacts, artefact, and macula. Results: We reviewed the main OCT artifacts including software break-down or misidentification of retinal layers, incomplete segmentation error, complete segmentation failure, mirror artifact (inverted artifact), cut edge artifact, degraded image scan, out-of-register artifact, off-center artifact, motion artifact, foveal duplication, segmentation shift, blink artifact, static or fixed image artifact, linear artifact, and perfluorocarbon liquid-producing artifact. Conclusions: There are various artifacts in OCT image scans. The identification of these artifacts may help in accurate interpretations of OCT images in clinical settings that can affect the diagnosis and management of different retinal disorders.

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Purpose: To report the limbal allograft transplantation and penetrating keratoplasty (PK) results in limbal stem cell deficiency (LSCD)-developed eyes because of chemical or thermal injury. Methods: Medical records of 18 eyes of 14 patients who had undergone keratolimbal allograft (KLAL) or living-related conjunctival limbal allograft (lr-CLAL) with or without PK and followed up at least 1 year postoperatively were evaluated retrospectively. The preoperative LSCD grade was noted in all patients. Rejection incidents, recurrence of LSCD, and corneal graft clarity along with a visual improvement during the follow-up were noted. The complications rate due to surgery or injury itself, for instance, glaucoma and cataract, were evaluated. The limbal allograft tissue survival analysis and corneal allograft survival analysis were done to reveal the differences in both the procedures. The existence of normal corneal epithelium and improvement in visual acuity were accepted as the surgical success criteria. Results: In the limbal allograft transplantation group, the survival rates of the allograft tissue were 65 ± 10.7% at 1 year and 36.6 ± 11.4% at 3 years in lr-CLAL and 66.7 ± 15.7% at 12 months and 53.3 ± 17.3% at 18 months in KLAL-transplanted eyes. The survival rate of corneal allograft at the 5^th postoperative year was lower in the simultaneous procedure compared to the staged procedure, but it was not statistically significant (25.7 ± 25.8% vs. 62.5 ± 17.1%, P = 0.75). The ambulatory vision was achieved in 10 eyes (56%) after a mean follow-up time of 93.8 ± 37.8 months. The visual acuity level has increased in 12 eyes (67%) in which the limbal allograft transplantation was applied. The ambulatory visual acuity level was achieved (≤1.0 logMar [20/200]) in 10 eyes (56%). In addition, two or more Snellen lines' gain in the best corrected visual acuity was observed in 12 eyes of 18 (67%) at the last follow-up, and there was not any significant difference between the KLAL and lr-CLAL. Conclusions: Ocular surface integrity was longer in KLAL than in lr-CLAL transplantation, but it was not statistically significant. The staged procedure was more convenient than the simultaneous procedure in terms of corneal allograft clarity maintenance in limbal allograft-employed eyes.

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Purpose: To report clinical features, pathology characteristics, and treatment outcomes of five patients with Rosai-Dorfman disease (RDD). Methods: A retrospective case series of patients with RDD from the Ocular Oncology Service of Wills Eye Hospital between 1974 and 2018. Results: There were six eyes of five patients (3 males, 2 females) with ophthalmic manifestations of RDD. The mean age at the initial presentation was 33 years (median 35, range 10–52 years). Before referral, the tumor was initially suspected to be lymphoma (n = 3), idiopathic orbital inflammation (n = 2), or pterygium (n = 1). The disease was unilateral (n = 4) or bilateral (n = 1). The mean duration of symptoms was 9 months (median 8, range 5–24 months). The disease produced nodules in the conjunctiva (n = 4) or orbit (n = 2). Two patients with conjunctival involvement had corneal involvement. One patient with bilateral conjunctiva lesions demonstrated bilateral orbital involvement and bilateral anterior uveitis. The mean tumor basal dimension was 13 mm (median 9, range 6–27 mm) for conjunctiva lesions and 37 mm (median 37, range 34–40 mm) for orbital lesions. The main symptom (per patient) included proptosis (n = 2), palpable mass (n = 1), and foreign body sensation (n = 2). No patient experienced pain or tenderness. Palpable, nontender lymphadenopathy was detectable in two patients in the cervical and inguinal lymph nodes. Systemic involvement with paranasal sinusitis and mediastinal/pulmonary lymphadenopathy occurred in two patients, both with orbital involvement. Surgical resection was performed for all patients. At a mean follow-up of 31 months (median 12, range, 10–76 months) after the surgery, tumor control was achieved in all six eyes without local recurrence. Conclusion: In this series of six eyes with RDD, patients with orbital and/or intraocular disease were more likely to demonstrate lymphadenopathy and systemic involvement, while those with unilateral perilimbal conjunctival tumors remained localized.

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Purpose: To assess the postoperative surgical outcomes and the changes in deviation in patients treated by supramaximal recession and resection (R&R) of rectus muscles to correct the large-angle exotropia and esotropia. Methods: This study was a prospective interventional case series, and patients with esotropia of ≥65 prism diopter (PD) or exotropia of ≥60 PD who had undergone supermaximal R&R in non-fixating eye with lower vision in unilateral strabismus or bilateral medial rectus (BMR) recession up to 8.5 mm for esotropia and bilateral lateral rectus (BLR) recession up to 12.5 mm for exotropia in bilateral strabismus were enrolled. Successful results were achieved if postoperation deviation was <10 PD for esotropia and <15 PD for exotropia during their final examinations. Results: A total of 131 cases (48 patients with esotropia and 83 patients with exotropia) were included. The mean ages of the patients with esotropia and exotropia were 16.83 ± 15.06 and 23.19 ± 11.29 years, respectively. The mean preoperative esodeviations for bilateral and unilateral surgeries were 69.5 ± 6.5 and 80.7 ± 10.3, respectively, and these values for bilateral and unilateral exodeviations surgeries were 67.3 ± 7.6 and 74.2 ± 12.1, respectively. The overall successful outcomes were achieved in 50% of the esotropic patients and 79.5% of the exotropic patients. At final follow-up examination, no patient had diplopia on lateral gazes. Conclusion: Based on our surgical results, it is possible to consider monocular recession-resection surgery in non-fixating eye (with poor vision) or BLR and BMR recession in both eyes as a viable option for surgical treatment of large angles deviations.

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Purpose: To determine the effect of smoking on tear stability and ocular surface of the cornea among students aged between 19 and 25 years. This study also aimed to find a correlation between tear film stability with a score of McMonnies Dry Eye Questionnaire (MDEQ) and Ocular Surface Disease Index Questionnaire (OSDI). Methods: This is a prospective, non-interventional, comparative study of 59 male (27 smokers and 32 non-smokers) undergraduates of a public university. Tear film stability was evaluated using non-invasive tear break-up time and fluorescein tear break-up time. Corneal staining was determined using Efron grading scale. MDEQ and OSDI Questionnaires were used to assess dry eye symptoms. Data were obtained from the right eye only and analyzed using descriptive and correlation analysis. Results: The age range of the participants was between 19 and 25 years. The mean age for smokers and non-smokers was 22.19 ± 2.20 and 21.22 ± 1.83 years, respectively (P = 0.07). The smoker group had statistically significant lower tear film stability than the non-smoker group (P < 0.0001). Corneal staining was statistically significant higher at the nasal and temporal parts of the cornea in smokers (P < 0.05). There was a moderate correlation between tear film stability and scores of MDEQ and OSDI. Conclusions: Tobacco smoke has a significant effect on the tear film stability, seen in reduced tear stability values among smokers. Corneal staining was found to be more extensive in the smokers. These findings would be useful to eye-care providers in the management of their dry eye patients related to smoking.

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Purpose: To present the management of upside-down Descemet membrane endothelial keratoplasty (DMEK) following combined phacoemulsification with DMEK (phaco-DMEK) in cases of Fuchs endothelial dystrophy (FED). Methods: This is a comparative interventional case series extracted from a prospective interventional case series (clinical outcome of DMEK combined with phacoemulsification for FED). We report five cases of upside-down DMEK. Two cases of upside-down DMEK were managed with re-orientation and the other two with repeat DMEK. The 5^th case underwent an initial re-orientation and then a subsequent repeat graft. Graft re-orientation and repeat surgery were performed 9–20 days after initial phaco-DMEK. All the five cases were followed up over a 6-month period, and the following outcomes were assessed: best corrected visual acuity (BCVA), contrast sensitivity (CS), central corneal thickness, endothelial cell density (ECD), and central macular thickness. Results: At the final 6-month postoperative follow-up, all the five cases achieved good outcomes in terms of BCVA and CS. Overall, the results were comparable to 32 control cases. One case of re-orientation and the case of re-orientation with subsequent repeat DMEK performed slightly less well than control cases in terms of postoperative ECD. Conclusions: Re-orientation of the original DMEK scroll in cases of upside-down DMEK can be a safe and cost-effective alternative to repeat DMEK. If re-orientation does not result in corneal deturgescence, a repeat DMEK may be done subsequently.

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Purpose: To assess the visual outcome and complications following retropupillary-fixated iris-claw intraocular lens (IOL) implantation. Methods: For this retrospective, non-comparative study, chart review of patients who underwent retropupillary iris-claw IOL implantation for the correction of aphakia from July 2014 to October 2018 and had a minimum postoperative follow-up of 2 months was carried out. Postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), and complications were noted. Results: One hundred and twenty-two eyes of 122 patients (mean follow-up: 7.48 ± 5.2 months, range, 2 months-3.5 years) were enrolled in the study. The mean logMAR CDVA improved from 1.36 ± 0.52 preoperatively to 0.5 ± 0.42 postoperatively, at the last follow-up visit (P < 0.0001). The final CDVA improved in 110 eyes (90.2%), remained unchanged in 8 eyes (6.6%), and worsened in 4 eyes (3.3%). In cases of pre-existing cystoid macular edema (CME) or excessive intraoperative manipulations, 0.05 ml of 4 mg intravitreal triamcinolone acetonide (IVTA) was injected at the end of the surgery. Twenty eyes (16.4%) had transient ocular hypertension (OHT), 6 eyes (4.9%) had persistent OHT, and 2 eyes (1.6%) progressed to glaucoma. Choroidal detachment was noted in 2 eyes (1.6%), CME in 6 eyes (4.9%), 2 eyes (1.6%) had retinal detachment, 20 eyes (16.4%) had significant ovalization of pupil, 8 eyes (6.6%) had one haptic disenclavation, 1 eye (0.8%) had corneal decompensation, and 1 eye (0.8%) had endophthalmitis. Conclusions: Retropupillary iris-claw IOL provides good visual rehabilitation with a few complications. Its ease of insertion and short surgical time makes it a good option to correct aphakia in patients with an inadequate capsular support.

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Purpose: To study the clinico-microbiological profile and outcomes of infectious keratitis (IK) at a tertiary eye care center in North India. Methods: This is a retrospective, hospital-based, cross-sectional study. One thousand seven hundred and eighty-six corneal microbiological reports were identified from January 2017 to December 2018, out of which 625 patients of IK fulfilled the inclusion criteria. They underwent microbiological examination which included corneal scrapings, culture, and antibiotic sensitivity. Demographic features, signs and symptoms, risk factors such as associated trauma, previous ocular surgery, and use of corticosteroids were also recorded. Results: Of the 625 patients, 68.2% were male and 31.8% were female. The age group affected most was the sixth decade; 21.9% (137 cases). Trauma was the most common associated risk factor in 151 cases (24.2%) followed by previous ocular surgery in 111 (17.8%). Out of the 625 corneal scrapings, 393 (62.9%) were culture-positive. Bacterial culture accounted for 60.6% (238/393) and fungal cultures were 143 (36.4%). More than 50% of the bacterial keratitis cases and more than 60% of the fungal cases had a favorable outcome. Staphylococcus sp. and Fusarium sp. were the most common bacteria and fungus isolated, respectively. Only one-third of the cases required surgical intervention, and the remaining two-thirds were managed medically. Conclusions: In the current study, cultures were positive in 63% of cases, and the majority of cases had bacterial growth. Surgical intervention was needed in one-third of the cases. Management of corneal infections is incomplete without a good microbiological workup. Ophthalmologists should be encouraged to learn and practice basic staining procedures, and this should start early in the training years.

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Purpose: To determine the distribution of vertical cup-to-disc ratio (VCDR) and its relationship with ocular biometric indices. Methods: This study was conducted in 4737 individuals aged 45-69 years living in Shahroud who participated in the second phase of Shahroud Eye Cohort Study in 2014. All participants underwent eye examinations including the measurement of visual acuity and refraction, slit-lamp biomicroscopy, retinal examination, and fundoscopy. Normality index was used to describe data distribution, and a multiple beta regression, with adjustment for the effect of cluster sampling, was applied to explore the relationship between VCDR and the study variables. Results: The mean [95% confidence interval (CI)] VCDR was 0.297 (0.293-0.301) in all participants; 0.296 (0.291-0.302) in men and 0.297 (0.292-0.302) in women. The highest mean VCDR was seen in the age group 55-59 years (0.299, 95% CI: 0.292-0.307). The 97.5^th percentile was 0.600. According to multiple beta regression analysis, VCDR had a positive association with the female sex (P = 0.028), spherical equivalent (P < 0.001), cigarette smoking (P = 0.020), and axial length (P < 0.001), and had a negative association with hypertension (P = 0.001), best corrected visual acuity (P < 0.001), hyperlipidemia (P = 0.029) and anterior chamber depth (P = 0.001). Conclusions: The mean VCDR and the 97.5^th percentile were lower than most other studies. Although ethnicity and race may play a role in this difference, this difference should be considered in clinical decisions in the current population.

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Purpose: To evaluate the multiple pretreatment characteristics and topographic factors of keratoconus (KC) patients and their relationship to clinical outcomes of corneal collagen cross-linking (CXL). Methods: In this prospective study, 61 patients (106 eyes) with KC as candidates for CXL were included. Demographic data including age, sex, place of birth and residence, atopic constitution, family history, rubbing history, sleep apnea, and blood group were collected via a structured checklist. Complete ophthalmologic examination and tear collection to assess tear interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) level were performed. Topometric parameters were evaluated using a rotating Scheimpflug topography device. Changes in best corrected visual acuity (BCVA) and maximum keratometry (K-max) were considered the main predicted variables. Predictive variables were analyzed by univariate and multivariate regression. Results: The use of multivariate analysis changes in K-max was significantly associated with rubbing frequency (coefficient = 0.94, P = 0.02), blood group (coefficient = 4.52, P = 0.005), pretreatment corneal asphericity (coefficient = −3.99, P ≤ 0.001), and pretreatment central keratoconus index (CKI) (coefficient = −55.38, P = 0.001). Regarding the changes in BCVA, the multivariate analysis showed a significant association with place of birth (coefficient = −0.08, P = 0.03), pretreatment BCVA (coefficient = −0.67, P < 0.001), pretreatment central corneal thickness (CCT) (coefficient = −0.005, P = 0.04), and pretreatment keratoconus index (KI) (coefficient = 0.53, P = 0.04). Other parameters assessed in the multivariable analysis did not appear to have an individual effect on treatment outcomes. Conclusion: Our results demonstrated that blood group, rubbing of eye, place of birth, corneal asphericity, pretreatment BCVA, CKI, KI, and CCT were statistically associated with the outcome of KC following CXL.

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Purpose: To review various treatment methods in thyroid eye disease (TED) related strabismus. Methods: We searched in PubMed and Google Scholar and Ovid MEDLINE for keywords including TED-related strabismus, strabismus in thyroid-associated ophthalmopathy, Graves^' ophthalmopathy related strabismus or squint, and restrictive strabismus. Two expert strabismus specialists selected and evaluated the English articles that were related to our paper and had been published since 2000. Some articles were added based upon the references of the initial articles. Results: One hundred fifteen articles were found, 98 of which were mostly related to the topic of this review. Management of TED-related strabismus was reviewed and categorized in non-surgical and surgical. Botulinum toxin A (BTA) is a useful non-surgical management of strabismus in an active TED and residual deviation after strabismus surgery. Postoperative under-correction is relatively more common in TED-related esotropia. Lateral rectus resection and BTA are the options to manage the problem. Muscle rectus muscle resection should be performed after maximum recession of restricted muscles. It should be avoided on a restricted or enlarged muscle. Management of TED-related vertical deviation is challenging. In these cases, the surgical treatment selected depends on forced duction test (FDT) (pre and intraoperative), orbital imaging (which muscle is enlarged), and the amount of vertical deviation (in both down-gaze and primary position). Conclusions: TED-related strabismus needs careful evaluation and management to achieve optimal outcome. Different surgical and non-surgical options are available for intervention in TED-related strabismus.

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Purpose: To develop the Persian version of MNREAD acuity charts and test their repeatability in a normal adult population. Methods: Two hundred sentences were constructed using the most frequent words of 8-year-olds schoolbooks. The number of characters and sentence length were adjusted based on the design principles of the Minnesota Low Vision Reading Test. Two Persian language teachers checked the sentences for syntax and meaning. The accepted sentences were read by 20 adults and then by 20 children. Using RADNER charts method, the sentences with inappropriate reading time and repeated errors were excluded. Thirty-eight sentences were approved to create charts. To check the charts' validity and repeatability, 20 adults read both charts and a paragraph of a daily newspaper. Reading acuity, critical print size, and maximum reading speed were calculated. The measured reading speeds were compared to the readers' reading speeds for a paragraph of a daily newspaper. Bland-Altman plots were used to evaluate the agreement between the two charts. Results: Thirty-eight selected sentences were used in the final printed charts. There were significant correlations between maximum reading speed for Charts 1 and 2 (r = 0.87, P <0.0001), Chart 1 and newspaper paragraph (r = 0.73, P = 0.001), and Chart 2 and newspaper paragraph (r = 0.83, P = 0.0001). Correlations were observed between reading acuities and critical print sizes of two charts (r = 0.72, P <0.002 and r = 0.77, P = 0.00). The 95% limits of agreement in reading acuity, critical print size, and reading speed between Charts 1 and 2 were ± 0.034 logMAR, ±0.11 logMAR, and ±8.00 words per minute, respectively. Conclusion: The designed Persian MNREAD charts are repeatable and could be used reliably to calculate near acuity, reading speed, and critical print size in Persian-speaking people.

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Purpose: To determine the vision-related quality of life (VR-QoL) and its dimensions in corneal transplant recipients. Methods: This cross-sectional study was carried out on 100 patients who underwent penetrating keratoplasty. Data collection tools included a demographic questionnaire, satisfaction questionnaire, and Persian version of the 39-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ 39). Results: The composite score of VR-QoL in corneal transplant recipients was 54.39 ± 9.22 (32.9–71.01). The highest mean score among subscales was related to color vision (74.75 ± 27.63) and the lowest related to dependency (31.06 ± 31.02). The results showed that there is a reverse correlation between VR-QoL with both age (r = −0.364;P < 0.001) and the numbers of years after the transplantation (r = −0.362;P < 0.001). However, there was a correlation between satisfaction and VR-QoL (r = 0.679;P < 0.001). Furthermore, the results showed that there is a significant difference in VR-QoL between men and women (P < 0.001) and also a significant difference in VR-QoL between unilateral and bilateral graft recipients (P < 0.001). Conclusions: The corneal transplant has the highest impact on color vision and the lowest on dependency. Moreover, the results of this study provide a comprehensive picture for the state of vision and overall health status of patients for health-care providers to enhance the patient care.

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Purpose: To determine the association between conjunctival epithelial dysplasia (squamous intraepithelial neoplasia) and its melanosis (microscopic non-proliferative melanin pigmentation) in conjunctival biopsies. Methods: In this retrospective case series, histopathological slides from all conjunctival biopsies obtained in Khalil Hospital affiliated with Shiraz University of Medical Sciences for a period of 6 years (April 2009–July 2015) were reviewed. After considering the exclusion criteria (non-melanotic pigmentation, melanocytic proliferations, and squamous cell carcinoma), conjunctival biopsies were divided histopathologically into two groups of dysplastic and non-dysplastic. Then, the slides were reviewed by one ophthalmopathologists and one general pathologist. Melanin pigmentation was recorded in both groups as 0, 1+, 2+, and 3+. The data were analyzed, and the groups were compared. Results: Overall, 685 cases with a mean age of 47.78 (±17.74) years were included in this study. Dysplastic and non-dysplastic groups comprised 135 (19.7%) and 550 (80.3%) specimens, respectively. Seventy-six percent (76%) of the specimens in the dysplastic group versus 40% in the non-dysplastic group had melanosis (P = 0.001). However, the degree of dysplasia (1+, 2+, and 3+) was not statistically correlated with the degree of melanosis (1+, 2+, and 3+) (P = 0.393). Conclusion: Our results demonstrated that melanosis is a common finding in conjunctival epithelial dysplasia and might indicate an association with conjunctival epithelial dysplasia.

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Purpose: To investigate the presence of a probable genetic defect(s) that may cause primary congenital glaucoma (PCG) in a seven-year-old female patient. Methods: A seven-year-old female patient and her family received genetic counseling and underwent full clinical examinations by an expert ophthalmologist. The patient's genomic DNA was subjected to the targeted gene capture and next-generation sequencing (NGS) along with Sanger sequencing method. The 3D structure prediction and stereochemistry analysis were performed for both mutant and wild-type forms of the CYP1B1 protein. Results: The clinical examinations indicated that the diagnosis of PCG was correctly made. We identified a novel homozygous deletion in which a “C” nucleotide was deleted from the final exon of the Cytochrome P450 Family 1 Subfamily B Member 1 (CYP1B1) gene. The 3D molecular modeling of the CYP1B1 protein predicted significant structural changes could occur in this protein as a result of the mutation mentioned earlier. The stereochemistry analysis revealed mutant features of the protein, as well as significant misfolding and possible malfunctions in the mutant form of the CYP1B1 protein. Conclusions: This mutation might cause a frameshift in the translation process, leading to the malfunction of the CYP1B1 protein and development of glaucoma. This newly-identified mutation could be regarded as potential deletion mutation in genetic counseling and molecular examination for the detection of PCG disease in Iran.

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Purpose: To assess refractive error, gender, and age-related differences in corneal topography of a normal population with Oculus Keratograph 4. Methods: This cross-sectional study included a total of 500 normal eyes of 500 individuals with ages ranging from 10 to 70 years. All participants underwent detailed ocular examinations, including visual acuity measurement, slit-lamp examination, and refractive error evaluation. Slit-lamp examination was performed for all individuals to rule out apparent corneal diseases. Corneal topography parameters were assessed using Oculus Keratograph. The data were analyzed based on gender, refractive error, and age groups using independent sample t-test and one-way analysis of variance. Results: Of a total of 500 participants (age: 29.51 ± 11.53 years) recruited for the present study, 66.4% were female, and 33.6% were male. The mean spherical equivalent of refraction was − 0.98 ± 1.65 diopters. Significant differences were noted in steep keratometry (P = 0.035) and corneal astigmatism (P = 0.014) between genders. Assessment of the data based on refractive error revealed significant differences in an index of vertical asymmetry (P < 0.001), index of height asymmetry (P = 0.003), and index of height decentration (P = 0.011). Considering age groups, significant differences were observed in flat keratometry readings (P < 0.001), mean corneal astigmatism (P = 0.02), minimum radius of curvature (P = 0.037), and apex power (P < 0.001). Conclusions: There was a prominent variation in some topographic parameters based on gender, age, and refractive error. The information on corneal parameters obtained with Oculus Keratograph from normal eyes provides a reference for comparison with diseased corneas.

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Purpose: To report a rare complication of herpes zoster ophthalmicus (HZO). Methods: A 27-year-old man with a history of graft-versus-host disease (GVHD) presented with pain and redness in his left eye along with vesicular eruptions on the same side of the forehead from 40 days earlier. Results: In this case report, we present a case of HZO with severe limbal ischemia in a patient with ocular GVHD. The patient was administered with intensive topical preservative-free lubrication, topical preservative-free antibiotics, topical autologous serum 20%, topical non-preservative steroid (methylprednisolone 1%), and oral valacyclovir 1 g twice daily. The patient underwent amniotic membrane patch surgery on bulbar conjunctiva and cornea, lateral tarsorrhaphy, and punctal occlusion for the left eye. Conclusion: In this report, severe and extensive limbal ischemia caused by herpes zoster virus in an immunocompromised patient is reported.

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Purpose: To evaluate the predictive and associated factors in determining the visual outcome in patients having central retinal vein occlusion (CRVO)-related macular edema (ME). Methods: The charts of the patients who were treated due to CRVO-related visual disturbance were reviewed. The optical coherence tomography (OCT) images of eyes were analyzed, and disorganization of retinal inner layers (DRILs), ellipsoid zone (EZ) and external limiting membrane (ELM) disruption length, hyper-reflectivity of retinal inner layer (HRIL) existence, baseline and final visual acuity (VA), subfoveal thickness (SFT), subretinal fluid (SRF), and injection numbers were noted. The regression and correlation analyses were applied. Results: Thirty eyes of thirty patients were included in the study. The mean follow-up time was 17.5 ± 11 (8–47) months. The mean baseline VA was 1.4 ± 0.7 (0.2–3.1) logMAR. A total of 87 intravitreal injections were applied for the treatment of ME during the follow-up. The initial mean central subfield thickness was 795 ± 264 (1470–398) μm. HRIL and SRF were observed in 16 and 23 eyes at the initial visit, respectively. The final mean VA was 1.2 ± 0.9 (0.1–3.1) logMAR. At the final visit, additional OCT parameters were evaluated. The mean DRIL length was 463 ± 324 μm. The mean disruption length of EZ and ELM was 367 ± 247 μm and 414 ± 327 μm, respectively. The final mean SFT was 290 ± 91 μm. SRF presence at the initial visit was found to be associated with elongated EZ and ELM disruption length at the final visit (P = 0.03 and P = 0.04, respectively). On linear regression analyses, none of the baseline features (SRF, SFT, and HRIL) except baseline poor best corrected visual acuity were found to be predictive in anticipating the final visual outcome (P = 0.04). On linear bivariate analysis, the final poor visual outcome was found to be affected by EZ disruption length of ≥500 μm at the last visit (P = 0.02). Conclusion: Baseline VA was the only predictive factor in anticipating the final visual outcome. At the final visit, extensive disruption length of EZ in the subfoveal area was associated with a poor visual outcome.

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Purpose: To investigate the impact of glaucoma-associated vision loss on quality of life and social functioning in Indians. Methods: A cross-sectional study with prospective enrollment was conducted. Participants were divided as: mild, moderate, and severe. Severity of glaucoma was stratified by the degree of binocular visual field loss in accordance with the Nelson Glaucoma Severity Scale (NGSS). The Glaucoma Quality of Life-15 (GQL-15) and a self-developed social function scale (SFS) were utilized to assess patients' wellbeing. Results: A total of 260 patients (mean ± SD age = 58.1 ± 12.01 years; 106 females) participated in the study. Univariate analyses revealed a significant relationship between final quality of life score and number of anti-glaucoma medications (P = 0.01), previous surgeries (P = 0.00), patients age (P = 0.00), patients education level (P = 0.02), and severity of glaucoma (P = 0.00). Previous surgeries (P = 0.04) and severity of glaucoma (P = 0.00) were significant predictors of GQL-15 summary score. With increasing glaucoma severity, patients noted greater difficulty with peripheral vision, glare and dark adaptation, and outdoor tasks (P < 0.0001). Severe glaucoma also impacted patients' functional performance—a significant decline was observed in sense of personal (P < 0.0001) and social wellbeing (P < 0.0001). Conclusions: Patients with advanced glaucoma report significant decline in functioning, their ability to interact in community, take care of self, and do leisure activities. Glaucoma imposes greater social burden on the elderly by impacting their sense of personal safety. Targeted visual and social rehabilitative programs are necessary to improve their wellbeing and independent functioning.

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Purpose: To define the incidence, characteristics, and management of eyelid basal cell carcinoma (BCC) in Central Spain. Methods: This retrospective study investigates the characteristics and the outcome of eyelid BCC from 2000 to 2016 in a central region of Spain. Data were collected on demographics, skin phenotype, location of the eyelid lesion, clinical and histological diagnosis, surgery, commitment of surgical margins, and recurrence rate. Results: Primary eyelid BCC occurred in a mean of 20.6 lesions a year or 9.4/100,000 inhabitants/year. The mean age of BCC carriers was 69.4 ± 16.2 years, with no gender difference (P = 0.479), predominantly affecting Fitzpatrick II–III skin (81.3%) (P < 0.001). The most common location was the inner canthus (154/45.7%) (P < 0.001) and type nodular (215 cases/63.8%) (P < 0.001). The surgical margins were affected in 69 (20.5%) individuals, and the recurrence rate was 5.6 (95% confidence interval, 3.2–8.3) significantly higher in affected margins (P < 0.001). The most common location for recurrence was the inner canthus (P = 0.003), and the most common histological type for recurrence was sclerosing (16.7%), then multinodular (12.5%), and infiltrating (10.4%) with no significant difference (P = 0.27). Conclusions: The frequency of occurrence of eyelid BCC is much less than the estimated crude incidence for skin tumors involving all areas of the body in the Spanish population. Eyelid BCC is more common in the seventh decade of life, with no predilection for gender. Nodular histological type is the most common. The recurrence rate is 5.6%, depending on site and affected margins, even though clear free margins also can present with recurrence.

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Purpose: To report a rare occurrence of ocular dirofilariasis in Bosnia and Herzegovina and provide a short overview on clinical characteristics and treatment options for ocular dirofilariasis. Methods: A 75-year-old woman was admitted to the University Clinical Centre Tuzla with pain and redness in her left eye. A live, white, coiled, and active worm was noticed in subconjunctival space of bulbar conjunctiva. Results: After successful surgical extraction, the parasite was identified as the adult form of Dirofilaria repens. There were no signs of intraocular or systemic inflammation. Conclusion: Ophthalmologists should have in mind a possible infestation, especially in cases with repeated inflammatory reactions and swelling of the ocular region, which does not respond to conventional therapy.

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Purpose: To assess the possible association between keratoconus (KC) and serum levels of 25-hydroxyvitamin D (25OHD), Selenium (Se), Zinc (Zn), and Copper (Cu) and to compare it with age-matched healthy subjects. Methods: One hundred patients with KC and 100 normal subjects were included. The two groups were compared for serum 25OHD and serum levels of three trace elements: Se, Zn, and Cu. These factors were also compared between groups with different KC stages. Results: Serum 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). Although a lower level of 25OHD was found in severe stages of KC, it was not significantly different among different KC groups (P = 0.441). KC stage groups were not significantly different for mean serum Zn, Cu, and Se (P = 0.130, P = 0.98, P = 0.113, respectively). Although the Cu/Zn ratio was higher in cases than in controls, there was no significant difference between the two groups and between KC stages (P = 0.168, P = 0.143, respectively). Conclusion: Lower serum 25OHD, Cu, Zn, and Se were found in the KC group compared to the control group. The results of this study suggest that a lower antioxidative activity may be involved in the possible etiology of KC.

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Purpose: To determine the prevalence of refractive errors and visual impairment and the correlation between personal characteristics, including age, sex, weight, and height, with different types of refractive errors in a population of university students in the south of Iran. Methods: In this cross-sectional study, a number of university majors were selected as clusters using multi-stage sampling in all universities located in Kazerun (27 clusters of 133 clusters). Then, proportional to size, a number of students in each major were randomly selected to participate in the study. Uncorrected and corrected visual acuity, non-cycloplegic objective refraction and subjective refraction were measured in all participants. Results: The prevalence and 95% confidence interval (CI) of presenting visual impairment and blindness was 2.19% (1.48–3.23) and 0.27% (0.12–0.62), respectively. Refractive errors comprised 75% of the causes of visual impairment. The prevalence (95% CI) of myopia [spherical equivalent (SE) ≤ –0.5 D], hyperopia (SE ≥ 0.5 D), and astigmatism (cylinder power < –0.5 D) was 42.71% (39.71–45.77), 3.75% (2.85–4.51), and 29.46% (27.50–31.50), respectively. Totally, 49.03% (46.39–51.68) of the participants had at least one type of refractive error. There was a positive association between weight and myopia (1.01; 95% CI: 1.01–1.02), anisometropia (1.03; 95% CI: 1.01–1.06), and refractive errors (1.01; 95% CI: 1.01–1.02). In comparison with the age group 18–19 years, the odds ratio (OR) of astigmatism in the age group 26–27 years was 1.64 (95% CI: 1.03–2.61), and the OR of anisometropia in the age group ≥ 30 years was 0.21 (95% CI: 0.04–0.98). Conclusions: The prevalence of refractive errors, especially myopia, is higher in university students than the general population. Since refractive errors constitute a major part of visual impairment, university students should receive special services for providing corrective lenses and glasses to reduce the burden of these disorders.

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