Iranian patients with keratoconus had physical, emotional, and social impairment in QoL. The NEI-VFQ-25 might be applicable in further studies.

Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.

Purpose To report a case of endogenous Candida endophthalmitis that may cause catastrophic sight-threatening outcomes, after extracorporeal shock wave lithotripsy (ESWL) in a healthy woman. Case presentation A 32-year-old woman presented to the ophthalmology clinic with the symptom of blurred vision and floater in her right eye. She underwent ESWL for renal stone 1 week prior to her presentation. Fundus examination showed an elevated white lesion in para-fovea with fluffy border. Smear of diagnostic vitreous sampling showed pseudo-hypha and budding yeast. Systemic and immunologic and infectious workups were unremarkable. In our case, response to intravitreal and intravenous injection of amphotericin-B and oral fluconazole was dramatic. Six weeks after starting the treatment, infiltrative lesion completely disappeared. The authors review previous MEDLINE literature about this topic. Conclusion Endogenous Candida endophthalmitis following renal stone lithotripsy is a serious and rare intraocular infection that may happen in healthy individuals without any risk factors.

Anterior uveitis (AU) is the most common form of uveitis. The differential diagnosis of AU is broad, ranging from infectious etiologies to autoimmune causes. However, approximately half remain idiopathic. Infections are the vision-threatening causes of AU which should be ruled out by history taking and detailed physical examination combined with guided work up. We report a rare case of bilateral granulomatous AU following hepatitis A virus (HAV) infection in an immunocompetent patient. A 35-year-old male presented to our center with a chief complaint of pain and redness in both eyes 3 days prior to the presentation. The patient's medical and drug history was unremarkable. He had a history of river water consumption 20 days prior to presentation. The patient was diagnosed with acute bilateral granulomatous AU. All routine work up to investigate the etiology of the disease was unremarkable, except for the serology of acute HAV infection, which was positive. The patient was managed with the topical steroid and cycloplegic for 2 weeks with no recurrence at one-year follow up. Extra-hepatic complications of HAV were reported in previous studies including arthritis, urticaria, myocarditis, nephritis, and myositis. The mechanism of extra-hepatic complication of hepatitis A is unknown; however, immune-complex deposition is most likely the etiological cause. Our report represents a rare case of sudden onset with limited duration granulomatous AU as a presenting manifestation of HAV infection. Previous studies do not provide a direct evidence of granulomatous AU associated with the HAV infection.

Purpose: To compare the effects of accelerated corneal collagen cross-linking (CXL) in progressive keratoconus (KCN) patients via epithelium removal and transepithelial techniques, using Daya Disruptor (Duckworth and Kent, Hertfordshire, UK). Methods: This study is a double-blinded, randomized clinical trial. Patients with documented bilateral progressive KCN were randomized into two groups: one eye underwent epithelium removal (Group 1), and the fellow eye underwent epithelium disruption (Group 2). The primary outcomes were best corrected visual acuity (BCVA) and uncorrected visual acuity (UCVA), Scheimpflug-extracted keratometric indices, and anterior segment-optical coherence tomography-derived epithelial thickness profiles. These parameters were evaluated before and 12 months after CXL. Results: Sixty-four eyes from 34 patients with progressive KCN (34 eyes in the epithelium-removal group and 30 eyes in the epithelium-disruption group) were included. The mean ± standard deviation (SD) of age was 23.4 ± 3.8 years in the epithelium-removal group and 23.2 ± 3.5 years in the epithelium-disruption group. The mean ± SD of the preoperative spherical equivalent (SE), front maximum keratometry (K-max), back K-max, thickness of thinnest point, and corneal apex thickness were − 2.9 ± 3.0 diopter (D) and − 3.7 ± 3.1 D ( P = 0.183), 53.8 ± 5.15 D and 54.4 ± 5.53 D ( P = 0.653), −6.63 ± 2.40 D and − 6.68 ± 2.48 D ( P = 0.131), 459.2 ± 37.4 μm and 460.8 ± 32.7 μm ( P = 0.708), 470.5 ± 37.7 μm and 469.7 ± 33.1 μm ( P = 0.679), and 55.4 ± 4.97 μm and 54.6 ± 7.16 μm ( P = 0.767) in the epithelium-removal and epithelium-disruption groups, respectively. The mean ± SD changes of the UCVA and BCVA 12 months after CXL were − 0.1 ± 0.11 and − 0.02 ± 0.18 and − 0.04 ± 0.12 and − 0.02 ± 0.14 in the epithelium-removal and epithelium-disruption groups, respectively. No statistically significant improvement was observed in the UCVA and BCVA between the two groups ( P = 0.868 and P = 0.937, respectively). The mean ± SD changes of the SE, superior epithelial thickness, corneal apex thickness, and thickness of thinnest point 12 months after CXL were − 0.21 ± 1.1 D and + 0.32 ± 1.6 D ( P = 0.0001), −0.08 ± 0.26 μm and + 0.03 ± 0.33 μm ( P = 0.028), −23 ± 11 μm and − 2 ± 6 μm ( P = 0.0001), and − 25 ± 8 μm and − 3 ± 7 μm ( P = 0.0001) in the epithelium-removal and epithelium-disruption groups, respectively. Conclusions: This study showed that the epithelium-disruption CXL using Daya has a similar potential for halting KCN progression as the epithelium-removal CXL. However, regarding the 12-month changes, the epithelium-di...