Purpose To establish normative reference intervals (RIs) for retinal nerve fiber layer (RNFL) and optic nerve head (ONH) parameters measured using spectral-domain optical coherence tomography (SD-OCT) in a healthy Iranian adult population. Methods This prospective, cross-sectional study recruited healthy adults from the PERSIAN Organizational Cohort Study in Mashhad. All participants underwent comprehensive ophthalmic examinations and ONH imaging using the Optovue RTVue XR Avanti SD-OCT system. Data quality was ensured through standardized acquisition procedures and exclusion of scans with artifacts or inadequate signal strength. Outliers were identified and removed using distribution-appropriate statistical methods. Reference intervals were established in accordance with CLSI C28-A3 guidelines using nonparametric or robust parametric approaches, with partitioning by sex and age applied when statistically justified. Results A total of 487 healthy adults (mean age: 40.5 ± 7.3 years; 56.5% male) were included in the final analysis. Significant sex-related differences were observed in several ONH parameters, with males showing larger disc and cup areas and females demonstrating greater rim area and rim volume. Age-related trends were also evident, including increasing cup-to-disc ratios and progressive declines in rim area, rim volume, and average RNFL thickness across older age groups. Conclusions This study provides a population-specific normative RI dataset for RNFL and ONH parameters in healthy Iranian adults. These reference intervals enhance the clinical utility of SD-OCT and support more accurate diagnosis of glaucoma and other optic neuropathies in this population.

To establish reference intervals (RIs) for macular ganglion cell complex (GCC) parameters measured by spectral-domain optical coherence tomography (SD-OCT) in a healthy adult population. In this cross-sectional study, healthy participants underwent macular SD-OCT imaging. Reference intervals for GCC-related parameters, including inner retinal thickness, full retinal thickness, outer retinal thickness, asymmetry indices, and loss metrics, were established in accordance with CLSI EP28-A3 guidelines. Reference intervals were calculated using non-parametric rank-based methods or robust parametric approaches with bootstrap-derived 95% confidence intervals. A total of 491 participants (mean age 40.62 ± 7.35 years; 218 females and 273 males) were included. Thickness-based GCC parameters demonstrated approximately symmetric distributions with low variability, whereas loss-based indices showed greater dispersion. Pooled reference intervals were appropriate for most GCC parameters. Sex-specific partitioning was required only for outer retinal thickness measures, with males demonstrating slightly higher values than females. Age-based partitioning was generally not required, although selective age dependence was observed for certain loss-related indices. The overall reference interval for inner retinal average thickness was 86.56–108.96 μm, and for outer retinal average thickness 161.68–192.66 μm. This study provides robust, CLSI-compliant reference intervals for GCC parameters measured by spectral-domain OCT in healthy adults. These normative data may serve as a reference framework for future studies investigating GCC alterations in glaucomatous and neuro-ophthalmic diseases and may contribute to the development of population-specific diagnostic and monitoring strategies.

We aim to describe a patient with papillophlebitis and concurrent cilioretinal artery occlusion associated with heterozygous methylenetetrahydrofolate reductase (MTHFR) gene mutation. A 20-year-old man presented with a history of transient visual loss. On examination, visual acuity was 20/25 in the right eye and 20/20 in the left eye and a positive right relative afferent pupillary defect (RAPD). Fundus examination revealed optic disc swelling with peripapillary subretinal hemorrhage, and vascular tortuosity. Findings were most consistent with papillophlebitis and concurrent cilioretinal arterial occlusion. The patient was evaluated for systemic disorders, which identified a mildly elevated homocysteine level. Molecular testing revealed MTHFR C677T heterozygosity. The patient received a single intravitreal aflibercept injection. At the 8-week follow-up, visual acuity improved to 20/20 in the affected eye, with complete resolution of retinal hemorrhages and optic disc swelling and residual atrophy of the inner retinal layers. Heterozygous MTHFR gene mutations may represent an independent thrombosis risk factor; therefore, we advise ophthalmologists and clinicians to perform a thorough systemic work-up and targeted thrombophilia testing in otherwise healthy patients who present with signs of papillophlebitis.

In this study, we introduced a new optical coherence tomography index, Macular Hole Reflectivity Index (MHRI), for macular hole surgery prognosis. Visual acuity improvement is unpredictable in macular hole surgery, and as the reflectivity of RPE can be a biomarker for the status of RPE, we aimed to evaluate the new index in terms of anatomical and visual outcomes. A retrospective consecutive case series of 48 patients with idiopathic full-thickness macular hole (FTMH) who had undergone pars plana vitrectomy with inverted internal limiting membrane (ILM) flap was performed. To calculate the MHRI, the spectral domain optic coherence tomography (SD-OCT) images were converted into 8-bit greyscale images. The MHRI was defined as the ratio of Maximum central reflectivity / Minimum paracentral reflectivity. Analysis was performed to assess if the index was an independent predictor of post-operative VA, and the MHRI cutoffs were calculated based on the receiver operating characteristic curve (AUC) to evaluate the ability of indices to predict surgical and visual success. The MHRI was significantly lower in the surgical success group (p < 0.0001). MHRI was significantly correlated with the postoperative VA. MHRI exhibited an AUC value of 97.0

Background This study evaluated choroidal thickness in healthy Iranian individuals using enhanced depth imaging optical coherence tomography (EDI-OCT) and evaluated its correlation with demographic characteristics, laboratory test results, anthropometric measurements, cardiovascular assessments, and spirometry findings. Methods In this retrospective cross-sectional study, 437 eyes from 437 healthy Iranian subjects were included. The highest-quality images were selected from both eyes. Choroidal thickness was measured subfoveally and at 500 and 1500 µm nasal and temporal to the fovea using EDI-OCT. Subjects with abnormal eye examinations or any retinal or choroidal diseases were excluded. Statistical analyses were performed to explore correlations between choroidal thickness and demographic features, laboratory test results, anthropometric evaluations, cardiovascular assessments, and spirometry findings. Results A total of 437 eyes from 187 males and 250 females were examined. The average age of males (42.79 ± 6.27) was significantly higher than that of females (41.60 ± 5.37) (p = 0.03). The overall mean subfoveal choroidal thickness was 316.11 ± 63.83 µm. The average thickness for males was 319.88 ± 66.58 µm, while for females, it was 313.28 ± 61.68 µm, with no statistically significant difference. A weak but significant correlation was found between age and choroidal thickness (r= -0.17, p < 0.001). There were no significant differences in choroidal thickness between genders. Conclusion In healthy Iranian subjects, the mean subfoveal choroidal thickness was 316.11 ± 63.83 µm, and no significant gender-related differences were observed.

Posterior segment intraocular foreign body (IOFB) injuries are among the most severe forms of ocular trauma and are associated with highly variable visual outcomes. Identifying reliable prognostic factors remains clinically challenging. This longitudinal study included 117 patients who underwent surgical removal of posterior segment IOFBs at a tertiary referral center between 2016 and 2021. Demographic data, injury characteristics, ocular findings, surgical variables, and Ocular Trauma Score (OTS) were recorded. Best-corrected visual acuity (BCVA, logMAR) was assessed preoperatively and up to 12 months postoperatively. Univariate and multivariable linear regression analyses were performed to identify predictors of final BCVA. Mean BCVA improved significantly from 1.51 ± 0.84 logMAR preoperatively to 0.97 ± 0.77 logMAR at 12 months (P < 0.001). Poor visual outcome was significantly associated with the presence of RAPD, endophthalmitis, retinal detachment, traumatic cataract, and larger IOFB size. OTS demonstrated the strongest independent association with final BCVA (β = − 0.81, P < 0.001). Hammering-related injuries were associated with better visual outcomes. Visual outcomes after posterior segment IOFB injuries are largely determined by initial trauma severity. The Ocular Trauma Score is a robust predictor of final visual acuity and should be incorporated into early risk stratification and patient counseling.

Objective(s): Different ocular diseases, such as diabetic retinopathy and cataracts, could be induced by oxidative stress. Alpha-lipoic acid (ALA) exhibits antioxidant activity; however, its low aqueous solubility limits its ophthalmic use.[U1] Cationic nano-emulsions (NEs) have emerged as an effective method to enhance the bioavailability of drugs, particularly those with low water solubility. Traditional methods for synthesizing nano-emulsions typically involve multiple steps. In contrast, deployment of the microfluidic technique enables nanoassembly of NEs in a single step through a micromixer with improved efficiency and minimized reagents. Materials and Methods: In this research, ALA cationic NEs were synthesized utilizing a microfluidic device, with variations in total flow rates. The resulting formulations were characterized based on their size. The formulation identified as the most optimal underwent further assessment regarding its physicochemical properties. Following accelerated stability assessments, animal studies were performed to evaluate the safety of the formulation. Results: The findings indicated a loading efficiency of 79.92% for the optimized formulation. The synthesized nanoparticles exhibited satisfactory characteristics in terms of pH, refractive index, osmolality, and rheological properties. Ex vivo release test revealed the formulation released up to 59.3% of ALA. Furthermore, ALA was detected in both vitreous and aqueous humor during in vivo experiments. The formulation successfully passed accelerated stability tests and demonstrated good tolerance in the ocular environment of rabbits throughout the animal study. Conclusion: The cationic ALA nanoemulsion synthesized by microfluidics demonstrates favorable characteristics, along with high stability and tolerability, which have proven beneficial for subsequent evaluations.

Purpose: To investigate the timeline of retinal vascularization and associated risk factors in infants with retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB). Methods: This retrospective cohort study was conducted at the ROP clinic of the Khatam Eye Hospital from 2014 to 2023. The study included preterm infants diagnosed with ROP who received IVB injection. The primary outcome measure was the time to complete retinal vascularization, defined as the number of weeks from the IVB injection to the point when vascularization extended to the ora serrata. Results: The study population comprised 155 (49.7%) female and 157 (50.3%) male neonates. The average gestational age at birth was 28.83 weeks (±2.228), and the average birth weight was 1244.90 g (±406.291). The mean duration of hospitalization in the neonatal intensive care unit was 33.71 days (±18.193). The mean (standard deviation) age and weight at complete retinal vascularization were 60.92 (15.16) weeks and 6064.01 (1616.87) g, respectively. The mean time interval between IVB injection and complete retinal vascularization was 24.31 (13.64) weeks. Survival analysis revealed that infants born before 30 weeks or weighing <1500 g experienced longer durations to full vascularization (P < 0.001). In multivariate Cox regression analysis, none of the variables were identified as independent risk factors for the time to complete vascularization. Conclusions: This study investigated the duration required for complete retinal vascularization in infants with ROP who received IVB injections. In addition, it evaluated the influences of birth weight, age, and gender as critical factors affecting the time to complete vascularization.

Intravitreal injection is a preferred route for targeted drug delivery to the posterior eye. However, commercial non-biodegradable polymeric implants for fluocinolone acetonide (FA) often necessitate surgical removal after long-term release, reducing patient compliance and increase surgical risks. Biodegradable polymeric implants also typically exhibit an initial burst release. This study explores the development of an innovative biodegradable in-situ forming lipid liquid crystal (ISF-LLC) formulation for sustained FA delivery over two months via a single intravitreal injection without burst release. The optimized formulation, developed using Design of Experiment software, comprised phosphatidylcholine and sorbitan monooleate (PC: SMO 30/70 w/w

Thermal corneal injuries are uncommon but potentially vision-threatening. Full-thickness corneal perforation caused by monopolar electrocautery during cosmetic blepharoplasty is exceptionally rare and scarcely reported in the literature. We report a 27-year-old healthy man who sustained an accidental central full-thickness corneal perforation during elective upper eyelid blepharoplasty due to inadvertent contact with monopolar cautery. The patient presented with severe ocular pain, markedly reduced vision, and a shallow anterior chamber. Prompt intervention was performed under sterile conditions. The corneal perforation was sealed using N-butyl cyanoacrylate tissue adhesive, followed by placement of a bandage contact lens. Adjunctive topical and systemic medications were administered to prevent infection, control inflammation, and inhibit collagenolysis. At one-week follow-up, the adhesive remained intact with a stable anterior chamber and no evidence of leakage or infection. Visual acuity improved to 20/200, limited by central stromal opacity. Although long-term follow-up was unavailable, immediate tectonic stabilization was successfully achieved. This case highlights a rare but severe ocular complication of cosmetic blepharoplasty. Early recognition and rapid application of cyanoacrylate glue can effectively preserve globe integrity in small corneal perforations. Proper ocular protection is essential during periocular surgical procedures to prevent such catastrophic injuries.

Posterior segment disorders represent a leading cause of vision impairment worldwide and remain challenging to manage due to limitations in ocular drug delivery. Although intravitreal injections of triamcinolone acetonide (TA) are effective, they are invasive and require repeated administration, highlighting the need for sustained-release systems. This study aimed to develop in situ sustained-release formulations of TA using lipid liquid crystals (LLCs). Formulations were prepared with glyceryldioleate (GDO), phosphatidylcholine (PC), and 28% w/w N-methyl pyrrolidone (NMP) at PC:GDO ratios of 50:50, 40:60, and 60:40. Additionally, a TA-hydroxypropyl-β-cyclodextrin (HPβCD) complex was prepared. The formulations were characterized for rheological properties, morphology, degradation behavior, and water uptake. In-vitro release was assessed in phosphate-buffered saline (pH 7.4), while in-vivo pharmacokinetics were evaluated in rabbits, comparing a selected LLC formulation (right eye) with a TA suspension (left eye). The F5 formulation (40:60 PC: GDO) achieved sustained release of 35.4% over one month and exhibited superior stability, with 24.9% less degradation compared to F6 (60:40 PC: GDO), which showed undesirable drug crystallization. The TA-HPβCD complex demonstrated an even slower release (28%). F4 (50:50 PC: GDO) was selected as optimized formulation, demonstrated the lowest water absorption and degradation with consistent release profile. In-vivo studies further confirmed that LLCs provided a more controlled and prolonged release compared with conventional TA suspension. In conclusion, LLC-based formulations of TA offer a promising strategy for sustained intravitreal drug delivery. Their biodegradability, ease of preparation, and ability to provide prolonged therapeutic levels highlight their potential for improving the management of posterior ocular diseases.

Background:Several variables have been identified as risk factors for retinopathy of prematurity (ROP). This study evaluated the risk factors associated with the increased need for treatment in infants with ROP. Methods:In this longitudinal study, the medical records of premature infants referred to the ROP clinic of a tertiary referral center in northeast Iran between July 2014 and June 2022 were reviewed. Probable neonatal and maternal risk factors for the need for treatment were analyzed. Results:Of the 9692 referred neonates, 4634 (47.8%) were diagnosed with any stage of ROP. The majority (53%, n = 4141) were male. The mean gestational age (GA) was 32.71 ± 2.52 weeks, and the mean birth weight (BW) was 1812 ± 501 g. 427 (4.4%) of 9692 referred infants were treated. In multivariate logistic regression analysis, lower gestational age (OR, 0.65; 95% CI, 0.53-0.79; p < 0.001), lower birth weight (OR, 0.8; 95% CI, 0.68-0.93; p < 0.001), and longer length of stay in neonatal intensive care unit (NICU) (OR, 1.59; 95% CI, 1.55-1.63; p < 0.001) were significantly associated with the need for treatment. Conclusion:We showed that lower birth weight, lower gestational age, and more extended NICU hospitalization were significant predictors of the development of ROP and treatment-needed ROP. Besides, the prevalence of ROP was significantly lower among patients with maternal gestational hypertension.

To evaluate the association between optical coherence tomography angiography (OCTA) measured macular vessel density (VD) and fovea avascular zone (FAZ) parameters and several body composition parameters and anthropometric indices, using data from a large population-based cohort of seemingly healthy adults. A cross-sectional observational study utilized data from 424 participants in the PERSIAN Cohort Study. OCTA scans, with dimensions of 3 × 3 mm and 6 × 6 mm, were employed to assess macular VD in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and parameters of the FAZ. Body composition was evaluated through bio-impedance analysis with the InBody 770 analyzer. The relationships between OCTA metrics and anthropometric indices were analyzed using multiple regression and correlation techniques with false discovery rate correction. The study population had a mean age of 39.3 ± 7.7 years, with 47% identifying as male. The results indicated that males displayed higher SCP VD at the fovea. A noteworthy positive correlation was found between foveal SCP VD and factors such as skeletal muscle mass, basal metabolic rate, and waist-hip ratio. In contrast, the whole-image DCP VD and FAZ areas were negatively correlated with total body water, fat-free mass, and muscle mass. The findings suggest that macular microvasculature is influenced by age, sex, and various anthropometric characteristics. These results highlight the potential of OCTA in evaluating systemic health and vascular status through retinal imaging. Further research is needed to investigate these findings’ underlying mechanisms and clinical applications.

Purpose:To compare the efficacy and safety of Stivant® (biosimilar bevacizumab, CinnaGen, Iran) to Avastin® (innovator bevacizumab, Genentech, South San Francisco, CA) in premature infants with prethreshold type I retinopathy of prematurity (ROP). Methods:Preterm infants with bilateral prethreshold type 1 ROP were enrolled in this nonrandomized contralateral clinical trial. Bilateral intravitreal bevacizumab (IVB) was administered, with Stivant® injected in one eye and Avastin® in the other. Patients were followed up weekly for 4 weeks, then biweekly until complete retinal vascularization. Efficacy was evaluated based on disease activity regression (plus disease regression) and complete retinal vascularization. Safety was assessed through the monitoring of adverse events such as uveitis and endophthalmitis. Results:Forty-four infants were included in the study. The mean age at IVB injection was 34.5 weeks. Complete retinal vascularization occurred at a mean age of 60.02 weeks for Stivant® and 59.93 weeks for Avastin® (P = 0.59). Five patients (11.3%) underwent bilateral laser photocoagulation as rescue treatment. Our results showed that Stivant® was noninferior to Avastin® in retinal vascularization progress. However, this study cannot make definitive noninferiority claims due to the sample size and its design as a pilot investigation. No cases of endophthalmitis or uveitis were reported. Conclusions:Stivant® exhibited noninferiority to Avastin® in efficacy and demonstrated a comparable safety profile in treating prethreshold type I ROP. A definite conclusion requires more extended studies with a larger sample size.

To assess macular anatomical and vascular parameters in individuals working in iron ore mines using Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) imaging to explore potential correlations between this occupational exposure and retinal changes. Individuals from the Sangan iron ore mine in Iran were included in a comparative cross-sectional observational study. An age-matched normal control group was selected from healthy participants employed at Mashhad University of Medical Sciences. Following thorough medical evaluations, participants underwent OCT and OCTA imaging. The macular thickness profile, vessel density (VD) of the superficial (SCP) and deep retinal capillary plexus (DCP), and the area of the foveal avascular zone (FAZ) were measured in our cases and compared with age-matched normal controls. One hundred and one individuals, with an average age of 38.3 ± 5.59 years in the case group and 38.5 ± 5.59 years in the control group, were enrolled in the study. The difference in mean foveal thickness between cases (50.75 ± 9.13) and normal controls (50.38 ± 8.29) was not statistically significant (p = 0.758). Similarly, the mean VD in SCP and DCP for the case group (49.08 ± 2.20 and 49.32 ± 2.42, respectively) and the control group (49.45 ± 3.54 and 49.36 ± 3.97) did not show significant differences. Additionally, there were no significant changes (p-value > 0.05) in macular thickness and VD in other retinal regions when comparing the case and control groups. The research did not establish a significant association between occupational exposure in an iron ore mine and retinal structural changes or alterations in macular VD.

This study aims to design and evaluate various supervised machine-learning models for identifying premature infants who require treatment based on demographic data and clinical findings from screening examinations. We conducted a retrospective review of medical records for infants screened for retinopathy of prematurity (ROP) at our clinic over the past decade. We extracted demographic and clinical data, including eleven features: sex, maternal education, paternal education, birth weight, gestational age, ROP stage, zone of retinal involvement, age at examination, weight at examination, and CPR. We developed and assessed several classifiers: logistic regression (LR), decision tree (DT), support vector machine (SVM), naïve Bayes (NB), K-nearest neighbors (KNN), XGBoost, artificial neural networks (ANN), and random forest (RF). The target variable was defined as whether the neonate received any treatment during the follow-up period. Our analysis included data from 9,692 infants. Among the machine learning models evaluated, the XGBoost and ANN models achieved the highest accuracy at 96

Endophthalmitis is a severe, vision-threatening complication that can occur following open-globe injuries, presenting significant challenges to ocular health. This narrative review comprehensively examines the incidence, risk factors, microbial spectrum, clinical presentation, diagnostic approaches, and management strategies for endophthalmitis in the context of open-globe injuries. The review emphasizes the critical importance of prompt diagnosis and timely intervention to preserve visual function and prevent further complications. Key factors such as the nature of the injury, delays in treatment, and the presence of intraocular foreign bodies are discussed about their impact on prognosis. Additionally, the review explores evolving trends in antimicrobial therapy, surgical interventions, and preventive measures. By synthesizing current knowledge, this article aims to guide clinicians in optimizing the care of patients with open-globe injuries at risk for endophthalmitis and to identify areas for future research.

Purpose: This study used Optical Coherence Tomography Angiography (OCTA) to examine the progression of the macular flow profile over the course of a month following Pan-Retinal Photocoagulation (PRP). Materials and Methods: A total of Thirteen individuals in the earliest stages of Proliferative Diabetic Retinopathy (PDR) were included in this follow-up investigation. This study has excluded patients who have had prior therapy for Diabetic Retinopathy (DR) or any other retinal disease. Before and after PRP treatment, all participants had a comprehensive eye exam and had a macular optical coherence tomography angiography (AngioVue RTVue XR Avanti, Optovue, Fremont, CA, USA, software version: 2018,0,0,18) performed using a 6-by-6-millimeter scan size. Superficial and deep capillary plexus were analyzed. Results: 13 patients, 6 male (46%) and 7 female (54%), with PDR, participated in this study. The mean± Sd of the patient’s age was 55.25±9.28 years. Foveal Avascular Zone (FAZ), Deep Vessel Density (DVD), macular Superficial Vessel Density (SVD), and area alterations in PDR patients before and after PRP were not statistically significant, according to this study. Conclusion: Although a reduction in SFVD, DFVD, and FAZ area in the 1st month following PRP was shown. PRP in patients with early PDR stage of diabetic retinopathy did not have a significant effect on the macular vasculature during the first month of treatment.

BACKGROUND/OBJECTIVES:To evaluate the effectiveness of deep learning (DL) algorithms in diagnosing Retinopathy of Prematurity (ROP) cases that requires treatment using fundus images submitted to the ROP clinic as part of a telemedicine consultation system. SUBJECTS/METHODS:This retrospective cross-sectional study analysed 1700 RetCam fundus images from 141 preterm infants screened for ROP at Khatam-Al-Anbia Eye Hospital. The images underwent preprocessing using Contrast Limited Adaptive Histogram Equalisation (CLAHE), Automated Multiscale Retinex (AMSR), and a machine learning-based optimisation approach (ML). Various convolutional neural network (CNN) models such as MobileNet, ResNet-18, ResNet-50, and DenseNet-121, were evaluated for their diagnostic performance utilising accuracy, sensitivity, specificity, and F1-score metrics. RESULTS:Among the models tested, MobileNet with CLAHE preprocessing achieved the highest accuracy (91.39%) and sensitivity (94.90%), establishing it as the most effective model for ROP detection. DenseNet-121 with CLAHE preprocessing showcased high sensitivity (94.26%) but slightly lower accuracy (90.98%). Additionally, ResNet-50 with AMSR preprocessing also demonstrated high accuracy (90.58%) and sensitivity (91.44%). These findings underscore the feasibility of DL models for real-time ROP screening in telemedicine environments. CONCLUSION:MobileNet with CLAHE preprocessing exhibited the highest diagnostic performance in identifying treatment-requiring ROP, positioning it as a promising tool for AI-assisted screening. Further validation in varied clinical settings is necessary to confirm its real-world applicability.