Identification of a Missense Mutation in GJA8 Gene in an Iranian Family with Autosomal Dominant Congenital Cataract

Purpose

To identify the causative mutations of autosomal dominant (AD) congenital cataracts in a large Iranian family.

Methods

The complete and accurate family history and clinical information of participants were collected. A total of 51 family members, including 22 affected and 29 unaffected individuals, were recruited in this study. We performed whole exome sequencing to reveal pathogenic mutation. We used amplification refractory mutation system polymerase chain reaction and Sanger sequencing techniques to confirm segregation in patients and also to rule it out in the healthy participants.

Results

A known missense mutation, c.827C>T (S276F), in GJA8 was identified. This mutation was confirmed in all patients. Neither all healthy family members nor 100 healthy individuals who served as controls from general population had this mutation.

Conclusion

The missense mutation c. 827C>T in the GJA8 gene is associated with AD congenital lamellar cataract with complete penetrance in a six-generation Iranian family.

Effect of Pulse Mode Phacoemulsification on Corneal Endothelium Using Different Frequencies

Purpose:  To determine a safer mode using two different frequencies (10 and 60 pulses per second) in pulse mode phacoemulsification in moderate to severe cataract. Study Design:  Quasi experimental study. Place and Duration of Study:  Khatam-Al-Anbia Hospital, Mashhad, Iran, from 2017 to 2018. Methods:  We enrolled 145 patients with moderate and severe cataracts according to lens opacities classification system III (LOCS III). They were allocated to two different groups with different frequencies of pulse mode (10 PPS and 60 PPS) phacoemulsification. Post-operative parameters, including best-corrected visual acuity, corneal edema, endothelial cell density, central corneal thickness, and effective phaco time, were compared between the groups. Results:  Patients who had undergone surgery using 10 PPS pulse mode had better vision than those in the 60 PPS pulse mode group. Pulse mode with 10 PPS caused 0.112 reductions in log MAR in best-corrected visual acuity compared with the 60 PPS pulse mode group (p value = 0.001). The difference in corneal edema was significant between 10 and 60 PPS groups on the first and seventh days post-operatively (p-value < 0.0001). One month after surgery, corneal thickness increased in both groups and statistically more in 60 PPS group (p-value< 0.0001). Conclusion:  Pulse mode with lower frequency in moderate and hard cataracts preserves endothelial cells from damage. The mean effective phaco time is less with ten pulses per second pulse mode.

Correlation between keratometry and corneal incision before and after phaco surgery

Introduction: Cataract is a common cause of vision loss and blindness in humans. After surgical management of cataract, all efforts should be focused on reducing postoperative astigmatism thus providing an excellent vision to patients.

Aim: To determine the relationship between corneal incision and refraction changes before and after phacoemulsification surgery in 300 patients undergoing cataract surgery in Khatam hospital in Mashhad, Iran from January 2017 to April 2018.

Materials and methods: Three hundred patients (144 women and 156 men) with cataract undergoing phacoemulsification surgery were recruited in this cross-sectional study. Refraction, keratometry and visual acuity measurement were performed before surgery. Then, a steep-based incision in the cornea was made without stitches. A 3.2 mm corneal incision was made at two supratemporal and temporal sites. The patients were followed-up for one and six months, and one year after surgery monitoring their vision and refraction, and performing keratometric measurements.

Results: The mean age of the patients was 65.7&plusmn;9.54 years (age range, 42&ndash;84 years). No major complications were observed. The greatest mean of changes in corneal power was in the supratemporal incision (1.28&plusmn;0.6). Keratometry had a significant relation with the incision (p<0.04).

Conclusions: An incision made along the steepest meridian leads to flatness of this meridian, this effect being more pronounced at the supratemporal incision. A temporal incision is recommended in cases where there is little difference in the keratometry of the two axes.

Long-term Outcomes of Collagen Crosslinking for Early Keratoconus

Purpose

To evaluate the long-term outcomes of collagen crosslinking in early keratoconus.

Methods

Thirty eyes of twenty patients with early keratoconus were enrolled. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), objective refraction, subjective refraction, corneal topography and pachymetry were assessed before and 3, 6, 12 months and 9 years after performing collagen crosslinking surgery.

Results

The patients' mean age was 31.2 ± 5.59 years at nine-year follow-up (range, 25–44 years). The means of preoperative UCVA and BSCVA were 0.57 ± 0.34 and 0.15 ± 0.12 logMAR, respectively, and these values remained stable at the final follow-up (P = 0.990 and P = 0.227, respectively). The mean objective spherical equivalent decreased considerably from –6.00 ± 4.05 D preoperatively to –5.22 ± 3.71 D at the final follow-up (P< 0.05). The mean subjective spherical equivalent was –4.25 ± 2.87 D preoperatively and this value was stable at the last follow-up (P = 0.92). No considerable difference was found between the post- and preoperative mean objective cylinder values (P = 0.34). The mean subjective cylinder value changed significantly from –4.05 ± 1.85 D preoperatively to –3.1 ± 1.42 D at the final follow-up (P< 0.05). The mean central corneal thickness was 496.97 ± 45.95 µm preoperatively and this value was stable at nine-year follow-up (P = 0.183). No significant difference was found between the pre- and postoperative mean maximum and mean minimum corneal curvature values (P = 0.429 and P = 0.248, respectively). There were no significant postoperative complications.

Conclusion

Corneal crosslinking in early keratoconus seems to be a safe procedure that can effectively stabilize UCVA, BSCVA, subjective SE and CCT, while improving objective spherical equivalent.

Preferred Learning Styles among Ophthalmology Residents: An Iranian Sample

Purpose

This study was performed to assess the learning styles of a sample of Iranian residents through Kolb's and VARK questionnaires.

Methods

In this descriptive-analytical study, 45 ophthalmology residents of Mashhad University of Medical Sciences were enrolled. Kolb's and VARK questionnaires were provided, and residents were oriented and guided on how to complete them.

Results

Forty-three out of the forty-five ophthalmology residents completed the questionnaire (95.5% response rate). The preferred learning style among ophthalmology residents was assimilative (51.2%), followed by convergent (37.2%), accommodative (7.7%), and divergent (4.7%), based on Kolb's questionnaire. According to the results of the VARK questionnaire, most ophthalmology residents were auditory learners (34.9%), followed by multimodal learners (30.2%). In addition, there was no significant relation between genders, stage of residency, and Kolb's and VARK learning styles (P> 0.05 for all).

Conclusion

The most preferred learning styles of ophthalmology residents were assimilative and auditory. Considering the dominant learning styles of learners and incorporating various teaching methods are recommended to enhance the learning among residents.

Heritability of pachymetric indices using Pentacam Scheimflug imaging

AIM

To investigate the heritability of corneal thickness at the apex, entrance pupil centre, thinnest point, pachymetric progression index (PPI) and maximum Ambrósio relational thickness (ART_max) using Pentacam.

METHODS

The present cross-sectional and population-based study was conducted in two rural districts that were selected randomly. Individuals 5 years and older and data from households where one of the parents and at least one child participated in the study were considered for this analysis. All subjects were examined for visual acuity, refraction, biomicroscopy and, finally, Pentacam imaging. The heritability estimate was used to calculate familial aggregation of pachymetric indices.

RESULTS

Of the 3851 selected individuals, 3314 participated in the study. After applying the exclusion criteria, a total of 1383 individuals from 382 households were included in the analysis; of these, 754 (54.52%) were female. The mean age of the subjects was 37.23±19.35 years (from 6 to 93 years). The highest heritability was observed for corneal thickness at the apex (85%), and the lowest was for ART_max (27.62%). The heritability of other studied parameters, including corneal thickness at the entrance pupil centre, thinnest point and average PPI, was 82.0%, 77.0% and 31.49%, respectively.

CONCLUSION

The high heritability of the mentioned pachymetric parameters confirms the high correlation between these phenotypes and genetic factors and calls for genetic and molecular research to find related genes and to understand the aetiology of associated diseases, especially glaucoma and keratoconus.

Comparison between Tear Film Osmolar Cocentration and Other Tear Film Function Parameters in Patients with Diabetes Mellitus

Purpose

To evaluate tear film function in patients with diabetes mellitus (DM) using tear film osmolarity (TFO) measurements compared to other tear film function tests.

Methods

DM patients without any history of ocular surface disorder but with potential effects on the tear film were enrolled in this cross-sectional study. Data including dry eye symptoms, duration of DM, stage of diabetic retinopathy and blood hemoglobin A1c levels were recorded. Tear film break-up time (TBUT) and basic tear secretion (Schirmer test) were assessed. TFO was determined using the Tearlab Osmolarity System. The outcome measures were the difference between the mean values of TBUT, basic tear secretion and TFO in both the study and control groups.

Results

We recruited 51 DM patients and 20 control subjects with a mean age of 51.2 (range, 21 to 70) and 48.5 (range, 24 to 70) years, respectively. A total of 27 patients (53%) and 11 controls (55%) reported dry eye symptoms (p = 0.668). The mean TBUT was 10.2 ± 4.8 seconds in the study group versus 10.5 ± 2.8 seconds in controls, which was not significantly different (p = 0.747). The mean Schirmer test score was 8.1 ± 4.3 mm in the patients versus 10.1 ± 3.0 mm in the controls (p = 0.069). The mean TFO was 294.1 ± 12.9 mosmol/L in the patients versus 291.4 ± 14.5 mosmol/L in the controls (p = 0.456). It was significantly higher in patients with poor glycemic control determined by hemoglobin A1c > 8% (p = 0.003). TFO had a positive correlation with the duration of DM (p = 0.030) but not with the stage of diabetic retinopathy (p = 0.944). However, TFO showed a significant relationship with dry eye symptoms (p = 0.001).

Conclusions

TFO is impaired in patients with uncontrolled DM and is better correlated with glycemic control and dry eye symptoms than the TBUT and Schirmer tests.

Significant Association and Increased Risk of Primary Open Angle Glaucoma with TGFB2 Rs991967 Gene Polymorphism in North Eastern Iranian Patients

BACKGROUND

Glaucoma is one of the main causes of irreversible blindness. The most common type of glaucoma is primary open angle glaucoma (POAG). TGF-β2, the main TGF-β isoform in the eye, is critical for extracellular matrix production and angiogenesis. Genetic studies have shown that TGF-β2 gene (TGFB2) polymorphisms affect its expression in the eye. The aim of this study was to investigate the presence of the TGFB2 rs991967 polymorphism in POAG, and the effect of this polymorphism on clinical characteristics in POAG patients.

METHODS

This case-control study was conducted on 112 control participants and 112 POAG patients referred to Khatam-Al-Anbia Eye Hospital, Mashhad, Iran. The TGFB2 rs991967 polymorphism was genotyped by the PCR-restriction fragment length polymorphism (PCR-RFLP) method. The genotyping results and clinical findings were analyzed using SPSS version 16.

RESULTS

The most common genotype was AA, observed in 54.5% of the patients (P < 0.0001, OR 12.2, CI 95% for OR: 5.25 to 28.31). Moreover, the highest and lowest frequencies of the mutant A allele were seen in the patient and control groups with percentages of 73 and 40%, respectively. This difference was significant (P < 0.0001, OR: 3.9, CI 95% for OR: 2.6 to 5.9). No significant association was seen between the frequencies of the TGFB2 rs991967 polymorphism genotypes and clinical characteristics in POAG patients.

CONCLUSION

The TGFB2 rs991967 polymorphism has a direct and significant association with POAG and significantly increases the risk of developing POAG.

The Association Between the Transforming Growth Factor Beta-1 -509C>T Gene Polymorphism and Primary Open Angle Glaucoma in North Eastern Iran

BACKGROUND

Glaucoma is a common cause of irreversible blindness. Transforming growth factor beta-1(TGF-β1) is the main isoform of TGF-β superfamily in the eye. Overexpression of TGF-β1 is shown to be related with the glaucoma. Studies have shown that the presence of mutant T allele of TGF-β1 -509C>T polymorphism (rs1800469) is associated with increased gene expression. So, in present study, association of the TGF-β1-509C>T gene polymorphism and primary open angle glaucoma (POAG) in patients from north east of Iran was investigated.

METHODS

A case-control study was conducted on 112 POAG patients and 112 control participants. TGF-β1- 509C>T genotyping was done by PCR-restriction fragment length polymorphism (PCR-RFLP) method using Bsu36I restriction enzyme. Moreover, cup to disk ratio(CDR), intraocular pressure (IOP) and visual acuity (VA) were measured. The obtained results were statistically analyzed.

RESULTS

The highest frequency of genotype in the control group was related to CC genotype (44.6%), but the heterozygous CT genotype (45.6%) was observed as the highest frequency of genotypes in patient group (P value: 0.022, OR for TT genotype: 2.54 CI95% for OR: 1.22, 5.27). Also, the frequency of the T mutant allele showed a significant difference between case and control groups (P value: 0.005, OR: 1.73 CI95% for OR: 1.18, 2.53).

CONCLUSION

In conclusion, a significant association was seen between TGF-β1 -509C>T gene polymorphism and POAG disease and inheritance of mutant T allele is considered to be a risk factor for glaucoma in patients living in North Eastern part of Iran.

Distribution of IOP measured with an air puff tonometer in a young population

Purpose

To determine the normal range of intraocular pressure (IOP) in the young and its association with certain corneal parameters using a non-contact device.

Methods

Subjects were selected from students of Mashhad University of Medical Sciences through stratified sampling. All participants had visual acuity testing, corneal imaging, a comprehensive slit-lamp examination by an ophthalmologist, and IOP measurement using a non-contact air-puff tonometer.

Results

Of the 1280 invitees, 1073 (83.8%) participated, and 1027 were eligible. Mean IOP was 16.38 mmHg [95% confidence interval (CI): 16.22–16.53] in the total sample, 16.14 mmHg (95% CI: 15.84–16.45) in men, and 16.48 mmHg (95% CI: 16.31–16.66) in women. There was a significant IOP difference between myopes and emmetropes (P = 0.031). Based on the multiple linear regression model, IOP associated directly with age and central corneal thickness (CCT), and inversely with corneal diameter, spherical equivalent (SE), and keratoconus. Based on standardized coefficients of the regression model, CCT and SE had the strongest association with IOP.

Conclusions

In the present study, we demonstrated the IOP distribution in a young population using a non-contact method. CCT and SE were strongly associated with IOP.

Sex-specific incidence rates and risk factors of insulin resistance and β-cell dysfunction: a decade follow-up in a Middle Eastern population

AIMS

To examine the incidence of and risk factors for insulin resistance and β-cell dysfunction in a representative Iranian population over a median follow-up of 9.2 years.

METHODS

In total, 3662 people (1528 men) without known diabetes with a baseline homeostasis model assessment of insulin resistance (HOMA-IR) level < 75th percentile and, when β-cell dysfunction was the outcome of interest, 3664 people (1530 men) with a homeostasis model assessment of β-cell function (HOMA-β) level ≥ 25th percentile were included in the study (HOMA-IR < 2.20 and HOMA-β ≥ 64.3 among men, and HOMA-IR < 2.39 and HOMA-β ≥ 81.7 among women).

RESULTS

The incidence rates of insulin resistance and β-cell dysfunction were 56.3 and 33.6/1000 person-years among men and 48.6 and 50.3/1000 person-years among women, respectively. Applying multivariable Cox regression in both sexes, fasting insulin, triglyceride/HDL cholesterol ratio and lower education were positive predictors of insulin resistance, whereas age was a negative predictor. Moreover, fasting plasma glucose, waist-to-height ratio, wrist circumference and lower hip circumference were significantly associated with incident insulin resistance only among women (all P < 0.05). Considering β-cell dysfunction in both sexes, age and fasting plasma glucose increased the risk, whereas 2-h post-challenge plasma glucose was a positive predictor only among men, and waist-to-height ratio and triglyceride/HDL cholesterol ratio were negative predictors only among women (all P < 0.05).

CONCLUSIONS

Modifiable risk factors are related to the incidence of insulin resistance and β-cell dysfunction, which can be prevented with proper strategies although the difference between men and women should be taken into account.

Pre-diabetes tsunami: incidence rates and risk factors of pre-diabetes and its different phenotypes over 9 years of follow-up

AIMS

To investigate the incidence of pre-diabetes and its different phenotypes and the related risk factors during 9 years of follow-up.

METHODS

A total of 5879 people (2597 men and 3282 women) aged ≥ 20 years, free of diabetes and pre-diabetes, took part in the study. Multivariable Cox proportional hazard models were used to evaluate hazard ratios (HR) and 95% confidence intervals (CI) for all potential risk factors.

RESULTS

Overall, 853 men and 902 women developed pre-diabetes. Incidence rates of pre-diabetes were 46.1 per 1000 person-years in men and 36.8 per 1000 person-years in women, while isolated impaired fasting glucose had the highest incidence rate among all pre-diabetes phenotypes. In both sexes, age, family history of diabetes, fasting plasma glucose and 2-hour post-challenge plasma glucose were related to incident pre-diabetes. Among women, waist-to-height ratio [HR: 1.02 (1.00-1.03)] and being divorced/widowed compared with married [HR: 0.67 (0.52-0.87)] were significant predictors of pre-diabetes; whereas among men, community-based intervention [HR: 0.79 (0.68-0.90)], higher level of education and being single [HR: 0.77 (0.6-0.97)] were protective against progression to pre-diabetes. Moreover, hip circumference among women [HR: 0.95 (0.93-0.98)] and current smoking among men [HR: 1.69 (1.15-2.48)] were related to incident combined impaired fasting glucose and impaired glucose tolerance.

CONCLUSION

More than 4% of the Iranian population develop pre-diabetes each year, emphasizing the important role of socio-economic factors (marital status, education and smoking habits) and community-based intervention in progression to impaired glucose regulations. Thus, emergent intervention is necessary to halt the tsunami of pre-diabetes among the Iranian population.

Wrist circumference as a novel negative risk factor for cardiovascular disease among adult men: a median follow-up of 9 years

PURPOSE

Wrist circumference is an easy to measure anthropometric index of body frame and bone size. The aim of this study was to examine the association of wrist circumference with incidence of cardiovascular disease (CVD) among adult men.

METHODS

For this study 2531 male participants aged ≥30 years, without any history of CVD were selected and followed from 1999 to 2011. Cox proportional hazard models and logistic regression were used to examine the relation of wrist circumference with incident CVD.

RESULTS

A total of 339 cases of CVD were reported throughout a median follow-up of 9.4 years. In the multi-variable Cox model, 1 unit increase of wrist circumference was inversely associated with incident CVD with a HR (95 % CI) of 0.84 (0.72-0.98, P value = 0.02). The receiver operating characteristics curve in a logistic regression model for wrist circumference in prediction of CVD showed a cutoff of 17.75 cm, beyond which was associated with a lower risk for CVD.

CONCLUSION

In a population with a high prevalence of CVD risk factors, it was shown that a higher wrist circumference was associated with lower risk for incident CVD. Further studies are needed to explore the underlying mechanisms of this inverse relation.

Presence of hypertension modifies the impact of insulin resistance on incident cardiovascular disease in a Middle Eastern population: the Tehran Lipid and Glucose Study

AIMS

To examine the independent impacts of the homeostasis model assessment of insulin resistance (HOMA-IR) and the updated model (HOMA2-IR) on incident cardiovascular /coronary heart disease in a Middle Eastern population with a high prevalence of cardiovascular disease risk factors.

METHODS

We examined 3777 Iranian people, aged ≥ 30 years, without history of cardiovascular disease and without use of antidiabetic medication at baseline. Both HOMA-IR and HOMA2-IR were log-transformed and categorized into quartiles. The multivariable Cox proportional hazard regression model, adjusted for traditional cardiovascular disease risk factors, was applied to examine the association between HOMA-IR/HOMA2-IR with incident cardiovascular/coronary heart disease, considering the lowest quartile as reference.

RESULTS

During a median follow-up of > 10 years, 197 cardiovascular disease and 181 coronary heart disease events occurred. Among the covariates, we found a significant interaction between hypertension and HOMA-IR/HOMA2-IR for incident coronary heart/cardiovascular disease (all P ≤ 0.01). Among the population without hypertension, the risk of cardiovascular disease significantly increased in the second [hazard ratio 1.96 (95% CI 1.04-3.68)], third [hazard ratio 1.93 (95% CI 1.00-3.75)] and fourth [hazard ratio 2.34 (95% CI 1.15-4.75)] quartiles of HOMA-IR, and the risk of coronary heart disease increased significantly in the fourth quartile of HOMA-IR [hazard ratio 2.30 (95% CI 1.12-4.73)], but no significant association was detected between HOMA-IR and cardiovascular/coronary heart disease in the population with hypertension. Among the populations both with and without hypertension, no risk was found to be associated with HOMA2-IR quartiles however, a 1-unit increase in HOMA2-IR was associated with a significant risk of cardiovascular disease among the non-hypertensive group [hazard ratio 1.60 (95% CI 1.03-2.48); P = 0.03].

CONCLUSIONS

The presence of hypertension modified the impact of HOMA-IR/HOMA2-IR on incident cardiovascular/coronary heart disease. The presence of insulin resistance highlighted a significant and independent risk for cardiovascular disease/coronary heart disease only in the population without hypertension.

Relationship of hyperinsulinaemia, insulin resistance and β-cell dysfunction with incident diabetes and pre-diabetes: the Tehran Lipid and Glucose Study

AIMS

To examine the association of fasting insulin, insulin resistance and reduced β-cell function with incident Type 2 diabetes and pre-diabetes (isolated impaired fasting glucose/isolated impaired glucose tolerance and combined impaired fasting glucose/impaired glucose tolerance).

METHODS

An Iranian population comprising 1532 men and 2221 women, aged ≥ 20 years, with normal fasting glucose and normal glucose tolerance at baseline, were enrolled in the study. Multivariable Cox proportional hazard models were used to calculate the hazard ratios and 95% CIs of fasting insulin, updated homeostasis model assessments of insulin resistance and β-cell function for incident Type 2 diabetes, isolated impaired fasting glucose, isolated impaired glucose tolerance and combined impaired fasting glucose/impaired glucose tolerance.

RESULTS

During a median follow-up of 9.2 years, the annual incidence rates (95% CI) of diabetes were 3.73 (2.74-4.94) and 4.06 (3.21-5.06) per 1000 person-years in men and women, respectively. In both men and women, fasting insulin and homeostasis model assessment of insulin resistance (≥ 75th percentile) were significantly associated with incident diabetes and combined impaired fasting glucose/impaired glucose tolerance; however, reduced β-cell function as measured by homeostasis model assessment of β-cell function (< 25th percentile) was associated with incident isolated impaired fasting glucose solely in men [hazard ratio 1.35 (95% CI 1.02-1.78)] in multivariable analysis including waist-hip ratio). Hyperinsulinaemia, insulin resistance and β-cell dysfunction were not related to the incidence of isolated impaired glucose tolerance in either gender.

CONCLUSIONS

Fasting hyperinsulinaemia and insulin resistance were strong risk factors for progression to diabetes and combined impaired fasting glucose/impaired glucose tolerance in a population with normal fasting glucose/normal glucose tolerance. In addition, impaired β-cell function at baseline was related to the development of isolated impaired fasting glucose only in men and, in both men and women, neither insulin resistance nor β-cell dysfunction were associated with incident isolated impaired glucose tolerance.

The effect of renal transplantation on ventricular repolarization in children with chronic renal failure

BACKGROUND

Chronic renal failure and hemodialysis affect many ECG parameters which can affect cardiac repolarization.

OBJECTIVE

To investigate the change in ventricular repolarization before and after kidney transplantation in children.

METHODS

A total of 45 children with end-stage renal disease, 45 children at least 6 months after successful renal transplantation, and 45 normal age-matched subjects were enrolled into this study. A 12-lead ECG was recorded in the 3 groups. QT dispersion, QTc dispersion, and T peak to T end (TPE) dispersion were measured.

RESULTS

In the patients before and after renal transplantation and the normal children, respectively, the mean±SD QT dispersion was 0.083±0.033, 0.056±0.029, and 0.033±0.016 (p<0.01); the mean±SD QTc dispersion was 0.104±0.038, 0.066±0.033, and 0.039±0.020 (p<0.01); the mean±SD TPE interval dispersion was 0.060±0.021, 0.045±0.021, and 0.034±0.019 (p<0.01). There was a significant correlation between left intra-ventricular diastolic diameter and QT dispersion, QTc dispersion, and TPE dispersion. The systolic velocity of the mitral valve also correlated with TPE dispersion (r=0.44, p=0.01).

CONCLUSION

In children with chronic renal failure, indices of ventricular repolarization improve after transplantation, though they still remain longer than the normal values.

Evaluation of growth and body mass index in children following kidney transplantation

Growth retardation is common among children with chronic kidney disease (CKD). Renal transplantation has beneficial effects on height and weight gain of children, but height gain occurs especially for those children who are transplanted at a younger age. This study was conducted for a cross-sectional evaluation of growth and body mass index (BMI) in children following kidney transplantation. All children who had been transplanted in our center and had regular follow-up were entered in this study. Those with primary non-functioning grafts were excluded from the study. Weight and height at transplantation and at 20 years of age or at a pre-determined period (1-4-2008 to 30-6-2008) were recorded. Their height, weight, BMI, standard deviation score (SDS) of height and weight at their pre- and post-transplantation period were compared. SPSS 15.1 software and paired t-test were used for comparison of means. Seventy-one children, 43 boys and 28 girls, were involved in this study. The mean age at transplantation was 12.6 ± 3.45 years, ranging from 3 to 19 years, and age at last visit was 16.9 ± 3.15 years. They had been followed-up for 7-175 months (mean, 51.6 ± 30.75 months). Their primary renal diseases were as follows: reflux, obstruction and dysplasia 29 (41%), hereditary 25 (35%), glomerular disease 14 (20%), unknown 3 (4%). Source of donor was living related in 27 (38%), with 15 being mothers, deceased in 35 (49%) and living unrelated in 9 (13%). SDS height improved dramatically in post-transplantation evaluation, but this did not happen for SDS weight and BMI. We can conclude that despite a dramatic effect of transplantation on growth, catch-up growth only occurred in a minority of the children.

The prevalence of anisometropia, amblyopia and strabismus in schoolchildren of Shiraz, Iran

PURPOSE

To determine the prevalence of amblyopia, anisometropia, and strabismus in schoolchildren of Shiraz, Iran.

MATERIALS AND METHODS

A random cluster sampling was used in a cross-sectional study on schoolchildren in Shiraz. Cycloplegic refraction was performed in elementary and middle school children and high school students had non-cylcoplegic refraction. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded for each participant. Anisometropia was defined as spherical equivalent (SE) refraction difference 1.00D or more between two eyes. Amblyopia was distinguished as a reduction of BCVA to 20/30 or less in one eye or 2-line interocular optotype acuity differences in the absence of pathological causes. Cover test was performed for investigating of strabismus.

RESULTS

Mean age of 2638 schoolchildren was 12.5 years (response rate = 86.06%). Prevalence of anisometropia was 2.31% (95% confidence interval [CI], 1.45 to 3.16). 2.29% of schoolchildren (95% CI, 1.46 to 3.14) were amblyopic. The prevalence of amblyopia in boys and girls was 2.32% and 2.26%, respectively (p = 0.945). Anisometropic amblyopia was found in 58.1% of the amblyopic subjects. The strabismus prevalence was 2.02% (95% CI, 1.18 to 2.85). The prevalence of exotropia and esotropia was 1.30% and 0.59%, respectively.

CONCLUSIONS

Results of this study showed that the prevalence of anisometropia, amblyopia, and strabismus are in the mid range. The etiology of amblyopia was often refractive, mostly astigmatic, and non-strabismic. Exotropia prevalence increased with age and was the most common strabismus type.

Effect of cataract type and severity on visual acuity and contrast sensitivity

PURPOSE

To determine the effect of cataract type and severity in eyes with pure types of age-related lens opacities on visual acuity (VA) and contrast sensitivity in the presence and absence of glare conditions.

METHODS

Sixty patients with senile cataracts aged 40 years or older with no other ocular pathologies were evaluated for VA and contrast sensitivity with and without glare. Lens opacities were classified according to the Lens Opacities Classification System (LOCS) III. VA was measured using the Snellen chart. Contrast sensitivity was measured with the Vector Vision CSV-1000E chart in the presence and absence of glare by calculating the area under log contrast sensitivity (log CS) function (AULCSF).

RESULTS

Cataracts were posterior subcapsular in 26 eyes, cortical in 19 eyes and nuclear in 15 eyes. VA significantly decreased with increasing cataract severity and there was significant loss of contrast sensitivity at all spatial frequencies with increasing cataract severity. AULCSF significantly decreased with increasing cataract severity in the presence and absence of glare conditions. Contrast sensitivity was significantly reduced at high spatial frequency (18 cpd) in cortical cataracts in the presence of glare in day light and at low spatial frequency (3 cpd) in night light.

CONCLUSION

Increased cataract severity is strongly associated with a decrease in both VA and AULCSF. Contrast sensitivity scores may offer additional information over standard VA tests in patients with early age-related cataracts.

Comparison of central corneal thickness measurement using ultrasonic pachymetry, rotating Scheimpflug camera, and scanning-slit topography

PURPOSE

To evaluate and compare central corneal thickness measurements using rotating Scheimpflug camera, scanning-slit topography, and ultrasound pachymetry in virgin, healthy corneas.

DESIGN

Prospective, observational, cross-sectional study.

METHODS

Central corneal thickness in 157 healthy eyes of 157 patients without ocular abnormalities other than refractive errors was measured, in a sequential order, once with rotating Scheimpflug camera and scanning-slit topography and 3 times with ultrasound pachymetry as the last part of examination. All measurements were performed by a single experienced examiner. The results from scanning-slit topography are given with and without correction for "acoustic correction factor" of 0.92.

RESULTS

The average measurements of central corneal thickness by rotating Scheimpflug imaging, scanning-slit pachymetry, and ultrasound were 537.15 ± 32.98 μm, 542.06 ± 39.04 μm, and 544.07 ± 34.75 μm, respectively. The mean differences between modalities were 6.92 μm between rotating Scheimpflug and ultrasound (P < .0001), 2.01 μm between corrected scanning-slit and ultrasound (P = .204), and 4.91 μm between corrected scanning-slit and rotating Scheimpflug imaging (P = .001). According to Bland-Altman analysis, highest agreement was between ultrasonic and rotating Scheimpflug pachymetry.

CONCLUSIONS

In the assessment of normal corneas, rotating Scheimpflug topography measures central corneal thickness values with higher agreement to ultrasound pachymetry.

Hypercalciuria in children with urinary tract symptoms

We performed this prospective study to determine the urinary calcium to creatinine ratio (Ca/Cr) in children with different urinary symptoms. We studied 523 children in our nephrology clinic with an age range of 3 to 14 years (mean= 8) and male to female ratio of 0.61. All the children had at least one of the urinary tract symptoms (dysuria, frequency, urgency, abdominal and/or flank pain, diurnal incontinence or enuresis), microscopic hematuria, urinary tract infection or urolithiasis. Fasting urine was collected for measuring calcium and creatinine and the results were compared to the values for the normal Iranian children. Ca/Cr ratio of more than 0.2 (mg/mg) was considered as hypercalciuria. Of all the patients, 166 (31.3%) were hypercalciuric. Urine Ca/Cr ratio was significantly higher in all the subgroups with one or more of the urinary symptoms (P< 0.001). We conclude that urine Ca/Cr ratio is significantly increased in children with all types of urinary symptoms. We recommend measuring urinary calcium in all children with urinary tract symptoms, especially if unexplained.

Abnormal Cambridge low-contrast grating sensitivity results associated with diabetic retinopathy as a potential screening tool

Contrast sensitivity is proposed as a potential screening tool for the early detection of diabetic retinopathy. A cross-sectional study was performed in a tertiary referral university eye centre. A total of 80 diabetes patients were recruited and tests were performed on 154 eyes. Contrast sensitivity was checked using Cambridge low-contrast grating. Abnormal contrast sensitivity was observed in 27.1% of eyes with diabetic retinopathy, compared with 9.0% in unaffected eyes, a statistically significant difference. Cambridge low-contrast grating is a potential screening tool for early detection of diabetic retinopathy by non-ophthalmologists.

Evaluation of insulin like growth factor-1 (IGF-1) in children with different stages of chronic renal failure

Growth retardation in children with chronic kidney disease (CKD) is multifactorial that include inadequate protein and calorie intake, persistent metabolic acidosis, calcitriol deficiency, renal osteodystrophy, drug toxicity, uremic toxins and growth factor abnormalities such as insulin-like growth factor (IGF) and IGF binding proteins. In this study, we compare the IGF-1 levels in normal and growth retarded CKD children. Serum IGF-1 levels were determined in 22 children with end-stage renal disease, 26 children with CKD at different stages, 23 children with normal height and weight for age and 23 children with constitutionally short stature. Mean serum levels of IGF-1 were 209 +/- 141 ng/ml in the ESRD group (group 1), 159 +/- 163 ng/ml in the CKD group (group 2), 420 +/- 182 ng/ml in normal children (group 3) and 360 +/- 183 ng/ml in children with constitutional short stature (group 4). The differences in the levels of IGF-1 in groups 1 and 2 were statistically significant when compared to groups 3 and 4 (p< 0.0001 and p< 0.02, respectively), while the levels of IGF-1 were not statistically different between groups 1 and 2. No correlation was found between IGF-1 levels and glomerular filtration rate, height or weight in groups 1 and 2. In conclusion, serum levels of IGF-1 in children with CKD are significantly lower than healthy children.

Visual outcome of extracapsular cataract extraction and intraocular lens replacement in leprosy patients

The study was carried out in Meshed, Islamic Republic of Iran, from 1998 to 2000 to explore the visual outcome of eye surgery with extracapsular cataract extraction and intraocular lens replacement on 18 leprosy patients [20 eyes]. The most common complications of leprosy were madarosis [90%] and partial or total corneal opacity [90%]. Visual acuity before surgery ranged from ‘light perception’ to 1/10, and this improved after surgery to 5/10-8/10 for 55% of patients. Postoperative infection leading to endophthalmitis occurred in only 1 patient and was treated with drugs; this patient’s visual acuity remained at 10 cm finger count. Posterior synechia due to chronic uveitis in leprosy was diagnosed in 70% of eyes, obstructed iris in 25%, keratic precipitates in 25% and moderate iris atrophia in 10%

Visual outcome of extracapsular cataract extraction and intraocular lens replacement in leprosy patients

The study was carried out in Meshed, Islamic Republic of Iran, from 1998 to 2000 to explore the visual outcome of eye surgery with extracapsular cataract extraction and intraocular lens replacement on 18 leprosy patients (20 eyes). The most common complications of leprosy were madarosis (90%) and partial or total corneal opacity (90%). Visual acuity before surgery ranged from 'light perception' to 1/10, and this improved after surgery to 5/10-8/10 for 55% of patients. Postoperative infection leading to endophthalmitis occurred in only 1 patient and was treated with drugs; this patient's visual acuity remained at 10 cm finger count. Posterior synechia due to chronic uveitis in leprosy was diagnosed in 70% of eyes, obstructed iris in 25%, keratic precipitates in 25% and moderate iris atrophia in 10%.

Pain tracker diagnostic instrument: effect on patients’ satisfaction with their interactions with the primary care physician

In a r and omized trial, the pain tracker instrument was evaluated as a diagnostic screening tool and for its effect on patients’ satisfaction with their interactions with the primary care physician. The instrument form was filled in by the physician after asking the study patients about symptoms. Control [n = 53] and study patients [n = 49] were interviewed and the instrument’s effect was analysed from responses to 15 statements. The pain tracker group were significantly more satisfied with the physician relationship than were controls [mean satisfaction score 85 +/- 8 versus 61 +/- 9]. A direct linear correlation was found between patients’ assessment of the visit and overall satisfaction [r = 0.86]. The pain tracker can be an important component in history taking and a useful diagnostic screening tool in pain presentations

Pain tracker diagnostic instrument: effect on patients' satisfaction with their interactions with the primary care physician

In a randomized trial, the pain tracker instrument was evaluated as a diagnostic screening tool and for its effect on patients' satisfaction with their interactions with the primary care physician. The instrument form was filled in by the physician after asking the study patients about symptoms. Control (n = 53) and study patients (n = 49) were interviewed and the instrument's effect was analysed from responses to 15 statements. The pain tracker group were significantly more satisfied with the physician relationship than were controls (mean satisfaction score 85 +/- 8 versus 61 +/- 9). A direct linear correlation was found between patients' assessment of the visit and overall satisfaction (r = 0.86). The pain tracker can be an important component in history taking and a useful diagnostic screening tool in pain presentations.