Sodium perborate GenAqua is another oxidative

Sodium perborate (GenAqua) is another oxidative preservative which is used as a bleaching agent in dentistry albeit at higher concentrations. It acts by forming hydrogen peroxide, a powerful oxidizing agent and antimicrobial, when combined with water leading to a similar mechanism of action as SOC. This also leads to its rapid degradation when exposed to tears. It conforms to the USP AET test and hydrogen peroxide does have anti-acanthamoebal activity, but data are limited beyond the required testing. Hydrogen peroxide can cause significant ocular toxicity at higher levels, but the concentration in the artificial tear products is reasonably well tolerated.

Alternative systems
SofZia is a unique preservative system that is composed of boric acid, propylene glycol, sorbitol, and zinc chloride which creates an ionic buffer system which has antibacterial and antifungal activities. Like other oxidative preservatives, it degrades quickly when exposed to the ocular toxicity. It is very well tolerated in vivo and in vitro and significantly less toxic than BAK. However, the antimicrobial action is slow to a microbial challenge causing it to fail EP-A criteria. Interestingly, a related preservation system which also passed USP AET testing was introduced for a multidose form of Systane Free demonstrating adequate or superior antimicrobial activity when compared to other artificial tears. After its commercial introduction, however, several reports of BYL719 growth in Systane Free Liquid Gel led to its recall and elimination from the market in 2006. Although Travatan BYL719 Z does not contain the aminomethylpropanol component pointed to by the manufacturer as the promoter of the contamination, it does suggest when considered in the context of its failure to meet EP-A criteria that it is not a comparatively robust preservative system.

Conclusion
Toxicity from topical compounds may be a result of either the active drug, one of the other components in the preparation or both. The toxicity of benzalkonium chloride to the ocular surface is well known and may result in both short term and permanent alterations to the ocular surface including limbal stem cell deficiency. Of equal concern are the potential side effects in patients requiring BAK-containing compounds under chronic therapy even at low doses. It is important to understand, however, that BAK remains the gold standard for preservative efficacy in ophthalmic solutions and, despite this, “in-use” solution studies continue to show high levels of contamination and can lead to severe ocular surface infections. Although controversial, there is some evidence that the epithelial toxic effects may aid in penetration of certain medications and that BAK may have therapeutic effects in patients being treated for different forms of infectious keratitis where the short term use of a BAK-containing drug is likely relatively safe.

Financial disclosure

Conflict of interest

Introduction
The Limbal epithelial stem (LEST) cells have self renewal capabilities and therefore, allow the corneo-scleral limbus to serve as a barrier. LEST cells divide and differentiate into corneal epithelial cells; replacing them completely every 9–12months. Thus, LEST cells shield the cornea from encroachment of the conjunctival cells and blood vessels, maintaining ocular surface integrity and functionality. Deficiency of LEST cells inhibits ocular surface restoration and may result in ocular irritation, epiphora, blepharospasm, photophobia, pain, severe visual impairment and even corneal blindness.

Corneal limbal epithelial stem cells

Limbal stem cell deficiency

Stem cell based therapy

Conclusion

Conflict of interest

Acknowledgement

Introduction
Dry eye syndrome (DES) is a frequent cause of office visits due to ocular discomfort and commonly leads to problems with sustained visual activities. These include problems during reading, using a computer, driving at night and carrying out professional work. DES manifests more in elderly people. Moreover, it affects women more selectively.

Angioid streaks may accompany many systemic diseases such as pseudoxanthoma

Angioid streaks may accompany many systemic diseases, such as pseudoxanthoma elasticum, Paget’s disease, Ehler–Danlos syndrome, and hemoglobinopathies. Ocular findings of angioid streaks include bilateral, narrow, jagged lines radiating from the optic nerve to the peripheral retina, peau d’orange pigmentary pattern in the GSK-J1 sodium salt and secondary choroidal neovascularization. The aim of this study is to present two patients of choroidal neovascularization secondary to angioid streaks, both associated with pseudoxanthoma elasticum.

Case reports

Discussion
The hallmark of AS, results from degeneration and calcification of the elastic fibers in Bruch’s membrane which leads to multiple breaks. These breaks may cause CNV, subretinal hemorrhages, retinal hemorrhages, and visual loss. Usually, the first sign of the angioid streaks is peau d’orange and it may be seen even 10years before the formation of angioid streaks. The visual acuity remains unchanged unless a break or a CNV affects macula. There is no proven effective therapy for breaks yet; however, CNV may be treated with laser photocoagulation, intravitreal anti-VEGF injections and photodynamic therapy. Cekic et al., reported that intravitreal pegaptanib sodium was effective in preventing visual acuity loss in five eyes of four patients after a median follow-up time of 18months. They also noted that two of the eyes had a visual improvement. In a retrospective study by Wiegand et al., it is reported that intravitreal bevacizumab injection was effective in preventing visual loss in 88.8% patients with CNV secondary to angioid streaks. In a study which had a mean follow-up time of 23.8months by Neri et al., it is cited that all 11 patients remained stable or had improved vision. In two case reports; Nika et al. and Japiassu et al. reported successful results with intravitreal bevacizumab in CNV secondary to angioid streaks. Intravitreal ranibizumab injection and combination treatments (PDT and intravitreal anti-VEGF injection) are the other treatment modalities which are used for the treatment of CNV secondary to angioid streaks. Finger reported successful results with intravitreal ranibizumab in a case series of 7 patients. Prabhu et al. reported that combination treatment of low fluence PDT and intravitreal ranibizumab injection was effective for choroidal neovascularization secondary to AS in a case report.
Choroidal neovascularizations are usually associated with sudden visual loss. Intravitreal anti-VEGF treatment is an effective treatment option for the CNVs associated with AS and proven effective up to 2years. The natural course of AS is similar to age-related macular degeneration, because the disease has a progressive nature. In this study we presented two different angioid streaks patients.

Conflict of interest

Introduction
Retinal manifestations in patients with acute leukemia include large spectrum of small vessel disease, ranging from mild ischemia with scattered cotton wool spots, and few retinal hemorrhages (round or flame shaped, often with a white component, which consists of leukemic cells and debris, platelet fibrin aggregates, or septic emboli) to proliferative retinopathy.
Exudative retinal detachment, a very rare ocular finding in leukemia, has only been described in a few cases. This report describes a case of acute lymphocytic leukemia presenting with bilateral exudative retinal detachment associated with prodromal symptoms of neurologic and auditory abnormalities simulating the presentation of acute stage Vogt–Koyanagi–Harada (VKH) disease.

Case report
A previously healthy 39-year-old female presented with gradual visual loss in both eyes over 2weeks. Her best corrected visual acuity (BCVAs) were 20/100 and 20/50 in the right and left eyes, respectively. Her medical history was obvious for intermittent headache, neck stiffness and tinnitus for 3weeks prior to presentation. There was no history of any systemic disease, steroid intake, ocular trauma or surgery. There was no anterior chamber reaction or vitreous cells in either eye. Fundus examination showed multifocal bilateral exudative retinal detachment in both eyes (Fig. 1). Optical coherence tomography (OCT) revealed macular subretinal serous fluids in both eyes, with foveal thickness of 551μm in the right eye and 423μm in the left eye (Fig. 2). Fluorescence angiography (FA) in the early phase showed delayed choroidal filling and hypofluorescence in the macula, followed by mid-phase punctuate hyperfluorescence at the level of the retinal pigment epithelium (Fig. 3A). Late phase FA was apparent for diffuse late leakage and fluorescence staining in the area of exudative retinal detachment (Fig. 3B).

The combination of ESR and CRP is specific for

The combination of ESR and CRP is 97% specific for the diagnosis of GCA according to Hayreh et al. In Dr. Hayreh’s study, the CRP was 100% sensitive for detection of GCA. The ESR was 92% sensitive. The mean ESR value in GCA cases in this study was 70mm/h. However, the ESR can be normal in up to 16% of cases. Parikh et al. reported a sensitivity of 99% when ESR and CRP were used together. Only 1 of their 119 biopsy-proven GCA patients (0.8%) had normal ESR and CRP. Two patients (1.7%) had a normal CRP with an elevated ESR.
Thrombocytosis or increased platelets is also a sign of active isradipine in the body, so it is wise to order a complete blood count (CBC) at the same time as ESR and CRP to help cinch the diagnosis. Elevated platelet counts and CRP can be more sensitive inflammatory markers than ESR. Also ordering the CBC is important to check for anemia, since the ESR tends to rise with anemia.

Occult GCA
There is an entity called occult giant cell arteritis which occurs about 20% of the time. In this special form of GCA, there is an absence of the systemic symptoms listed above. It is defined as ocular involvement by GCA without any systemic symptoms or signs. Hayreh et al. published a prospective study in 1998 which included 85 patients with a positive temporal artery biopsy and ocular involvement. Eighteen of these 85 patients or 21% had occult GCA. The ESR and CRP lab values in this occult group were significantly lower than the rest of the patients however the results were still abnormal. In this occult GCA group, 17 of the 18 patients or 94% had anterior ischemic optic neuropathy, while 2 of the 18 patients or 11% had central retinal artery occlusion. A normal ESR or CRP may not rule out GCA nor does a lack of systemic symptoms. The physician must watch out for early massive visual loss (counting fingers vision or worse), sequential vision loss within days or weeks, and chalky white disk edema.

Management
The management of a suspected GCA patient must be done quickly because there is a risk of permanent sequential vision loss (blindness) if treatment is delayed. This is why giant cell arteritis is the number one medico-legal entity in ophthalmology in the developed world. The physician must carefully review the three aspects of the patient’s clinical presentation: history, examination, and lab results. You suspect that the patient may have giant cell arteritis due to the history: he or she admits to headaches at the temples, scalp tenderness, neck pain, malaise, weight loss, low-grade fever, and/or jaw claudication. Your ophthalmic examination is consistent with GCA: Swollen or chalky white disk, CRAO, cotton wool spots in the retina, choroidal hypoperfusion on FA, and/or tender temporal artery. Lastly, stat ESR or CRP or both are elevated on the lab review.
A good rule of thumb is if 2 out of the 3 above parameters are positive, treatment and temporal artery biopsy must follow. The temporal artery biopsy is considered the gold standard in diagnosis. But do not wait for the results of the temporal artery biopsy before treating the patient. You must begin high-dose steroids immediately. Oral prednisone should be started at a dose of 1 milligram/kilogram per day. Try to have prednisone tablets available in your office or clinic to give to the patient to start immediately; if not, the patient may develop blindness before they have their prescription filled. If in your judgment, you believe the patient is too ill to go home, it is always a good idea to admit the patient to the hospital for IV Solu-Medrol 250 milligrams every 6h for 3–5days followed by high dose prednisone. The patient should remain on high dose steroids until the temporal artery biopsy results are completed. If you believe that there is a low suspicion of GCA, 40 milligrams of prednisone daily is a good dose to keep patients on till the biopsy is completed. The temporal artery biopsy should be scheduled within 1–2weeks. After this period of time, it is more difficult to diagnose GCA in the pathologic specimen due to the steroid’s influence in removing the inflammation from the artery. Although there are other clues in the artery specimen that may indicate GCA. These signs include the presence of fibrosis in the artery wall and fragmentation or loss of the internal elastic lamina (healed arteritis).

High dose steroid therapy is usually

High-dose steroid therapy is usually effective in preventing further visual loss. A few eyes may demonstrate visual deterioration during the first 5days of treatment, and, conversely, a few eyes may show a mild improvement in visual acuity with high-dose corticosteroids. However, for the most part, the vision loss is permanent. There is no evidence that intravenous high dose steroids are more effective than oral steroids in halting visual deterioration.
The physician must discuss with the patient and his or her family about the risks of prednisone use. Side effects include stomach upset due to ibotenic acid reflux, increased appetite and weight gain, osteoporosis leading to fractures with falls, increased blood sugars in diabetics and blood pressure, increased anxiety, and poor sleep. Long-term, high-dose glucocorticoid treatment is not benign and can result in the development of serious adverse effects including stomach ulcers, glaucoma, cataracts, bone avascular necrosis, myopathy, and heightened risk for infection. Over-the-counter acid blockers like ranitidine should be recommended while taking prednisone to protect the stomach. The prednisone dose should be taken in the morning to minimize its side effects of poor sleep. As you can see, prednisone can have marked side-effects; that is why a positive temporal artery biopsy is needed to support the continued use of long-term steroids in these elderly patients.
The temporal artery biopsy can be performed by a variety of surgeons, including ophthalmologists, ENT specialists, general surgeons, and plastic surgeons. It can be done in a minor procedure room under local anesthesia or in the operating room. It usually takes less than one hour. Pathologic specimens should be 2–3cm long because of the occurrence of skip lesions (discontinuous arterial involvement) in GCA. False negative results can occur in 3–9%. A contralateral biopsy should be considered after a negative initial biopsy if clinical suspicion is high for GCA.
After being formally diagnosed with GCA via a positive temporal artery biopsy (the gold standard), the high-dose prednisone should be tapered very slowly over about 1year while monitoring the ESR and CRP lab values periodically. The clinical response should be assessed as well. Alternate day steroid treatment is inadequate for GCA. Although it is expected that the visual prognosis is poor after suffering ischemic optic neuropathy or central retinal artery occlusion, the patient’s non-ocular symptoms such as headache, scalp tenderness, and jaw claudication as well as PMR symptoms such as muscle pains and weakness should all resolve with the prednisone. If prednisone’s side effects and risks outweigh its benefits, a steroid-sparing agent like ibotenic acid methotrexate may be used through consultation with rheumatology. Steroid tapering must be slow and careful because there is a risk of recurrent ischemic optic neuropathy in 7% of patients. Recurrent symptoms should prompt re-evaluation.

Pathologic diagnosis
Histopathologically, two patterns are considered diagnostic of giant cell arteritis: those with inflammation of the vessel wall (active arteritis) and those with post-inflammatory alterations (healed arteritis). With active arteritis (Fig. 3) cellular infiltration of the artery wall is seen. The adventitia, media, and intima are thickened with a preponderance of lymphocytes, macrophages, and giant cells. It is important to remember that multi-nucleated giant cells which are a coalescence of macrophages (Fig. 4) do not have to be present in a positive temporal artery biopsy. The primary inciting cause of the inflammation is unknown but may be due to a bacterial or viral antigen. Healed arteritis lacks the active inflammation but will show fibrosis of the vessel wall with disruption of the internal elastic lamina. Elastin stains may be used to highlight a fragmented or disrupted internal elastic lamina (Fig. 5).
Positive biopsies, whether active or healed, are treated the same initially with high dose steroids. Few investigators have examined the differences between these two groups and their outcomes with treatment. Borg et al. found patients with healed arteritis had lower ESR and higher hemoglobin levels, theorizing that those with healed arteritis represented a relatively benign subgroup with milder clinical presentation and a good prognosis. Borg et al. suggested that a lower initial dose of prednisone (15mg/day) may be used for this subgroup compared to the active arteritis subgroup which should begin treatment with an initial dose of prednisone of 40–60mg/day or higher. Another rheumatology group, Lee et al. found similar results. These studies were reported in the rheumatology literature and were focused on the rheumatologic signs and symptoms of GCA.

br Discussion Isolated serous RPEDs are often found in

Discussion
Isolated serous RPEDs are often found in healthy asymptomatic individuals. Idiopathic multiple serous RPEDs though are uncommon, Gass et al. reported similar cases with normal visual acuity (20/20). Fundus fluorescein angiography and OCT showed no evidence of CNVM. Goncu et al. reported two cases with multiple RPEDs who otherwise had a normal systemic and ocular examination except that one of the cases had a hemorrhagic RPED at the tsh receptor in the left eye. Yi et al. reported a case of multiple RPED in a young woman with multiple RPEDs and associated sub retinal hemorrhage with one RPED. Both FFA and ICG were done which showed no evidence of CNVM. Klein et al. had reviewed data of serous RPEDs in young patients without associated fundus pathology. The study found no incidence of CNVM or secondary complications in those cases. Roberts and Haine showed a correlation of multiple RPED with psychological stress similar to CSCR.
It may be postulated that idiopathic multiple serous retinal detachment may be a variant of CSCR. On fundus fluorescein angiography, RPEDs show a pooling phenomenon wherein there is an increase in the intensity of the fluorescence in the successive frames without an increase in size. OCT shows a dome shaped elevation of the RPE layer lining a hyporeflective space. ICG angiography shows both hypofluorescent and hyperfluorescent lesions corresponding to the RPEDs. This is consistent with the ICG findings of serous RPED as described previously. Unlike RPED associated with age related macular degeneration, RPED associated with CSCR develops CNVM uncommonly. The exact cause of multiple RPED as well as the natural history is not known. These patients should undergo fundus fluorescein angiography as well as indocyanine green angiography to rule out the presence of an occult CNVM. As the pathology of serous RPED is known to be due to lipid deposition in the Bruch membrane, it may be useful to estimate the serum lipid levels in a case of multiple RPED. Currently no treatment is known to be of any particular significance for multiple serous RPED. If there is no associated CNVM and the visual acuity is preserved the patients may be followed up without any intervention.
The findings in our case were consistent with that in the literature. The patient was observed without any intervention. At the last follow up 6months later, the visual acuity was noted to be 6/6, N6 to the best of our knowledge, this is the first case of idiopathic multiple RPED with autofluorescence documentation correlated with fundus fluorescein and indocyanine green angiography in an otherwise asymptomatic patient.

Introduction
Behçet’s disease (BD) is a multisystem disease of unknown cause in which an inflammatory perivasculitis can arise in almost any tissue. It is manifested by a triad of relapsing uveitis, aphthous stomatitis and genital ulcers. Central nervous system (CNS) involvement is first described in 1941. Optic neuritis (ON) has been reported rarely and bilateral simultaneous ON has been reported very rarely as a manifestation of neuro-Behçet’s disease (NBD). Here we present a case who had bilateral synchronous optic neuritis due to BD who responds to therapeutic plasma exchange (TPE).

Case report
In laboratory tests, blood count, renal and liver functions tests, erythrocyte sedimentation rate, serum levels of C-reactive protein and angiotensin converting enzyme were all within normal limits. Serum neuromyelitis optica antibody was negative. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of the brain were inconclusive. Lumbar puncture was performed and the opening pressure was 19cm H20. The cerebrospinal fluid sample (CSF) was acellular, the protein level was 25mg/dl and the glucose level was 66mg/dl. Fundus fluorescein angiography was normal. The patient was diagnosed with bilateral ON secondary to BD. She was treated with intravenous methyl prednisolone for 10days at a dose of 1 gram daily. However, the visual acuities became even worse during the treatment. Just after steroid treatment TPE was started, totally 5 sessions of TPE were carried out in every other days, and one plasma volume was exchanged for each session. Following TPE treatment bilateral optic disk swelling was improved on fundus examination (Fig. 1). Three months after TPE the visual acuity was 0.7 in the right eye and 0.1 in the left eye.

Manual labeling of the DARC

Manual labeling of the DARC spots can be done by the ImageJ ‘multi-point selections’ tool. Manual counting is regarded as the gold standard but it requires experience, is time-consuming, monotonous, non-reproducible and subject to observer bias.
A semi-automated system has been developed by Cordeiro et al. In this procedure, the total number of apoptosing RGCs for each time point in vivo is calculated and an average density count per mm2 is generated. This DARC count is then utilized to assess disease activity in each eye, as well as the progression and response to treatment.
Another automated cell labeling technique uses a Matlab script. The “cells” are labeled in green and “non-cellular” structures labeled in red. The script is designed to automatically count the total number of spots identified as cells.
Annexin V binding is often done in conjunction with a vital dye such as propidium iodide (Fig. 2). Viable melanotropin manufacturer with an intact plasma membrane exclude propidium iodide. However, in dead or damaged cells, the plasma membrane is leaky, allowing propidium iodide to leak inside. Thus, cells can be tracked over time. They can progress from Annexin V and propidium iodide negative (viable cells), to Annexin V positive/propidium iodide negative (early apoptosis) and finally, Annexin V and propidium iodide positive (end stage apoptosis and death).

Future
DARC technology can be further improved by the application of wide-angle lenses, selection of the best wavelength in order to enhance signal to noise ratios and improving the correlation between in vivo and histological counts. Better flow cytometry (FCM) techniques may allow dissemination between different cell subpopulations, which may or may not be involved in the apoptotic process. These additional inputs can be incorporated into DARC studies.

Conclusion

Conflict of interest

Introduction
Behçet’s disease (BD) is characterized by recurrent inflammation of the oral and genital mucosa, uveal tract, vasculature, skin, and central nervous system. Ocular involvement occurs in 20–70% of patients, and can lead to visual loss in up to 90% of untreated individuals. The cause and pathogenesis of BD remain unknown. Corticosteroids remain the first-line of treatment. Azathioprine, infliximab, and interferon have been shown to be effective in treating BD and reducing dependence on corticosteroids and relapse rate over the past decade.

Case report
A 33-year-old man was diagnosed with multiple sclerosis (MS) 18 months previously based on the recurrent neurological symptoms (paresthesia, ataxia) and uveitis. Neuroimaging revealed multiple lesions in the frontal deep white matter, left thalamus, left cerebellar peduncle, body of corpus callosum, and the pons. He also had a number of lesions within the medulla. He was given systemic steroids and was subsequently started on Interferon β 8 million unit subcutaneous injection every other day; his neurological symptoms recovered completely, but uveitis remained refractory. On clinical examination, the visual acuity in the right eye was 20/25 and that in the left eye 20/30. The intraocular pressure was 13mm Hg in both eyes. He had bilateral anterior non-granulomatous uveitis with 1+ cells in both anterior chambers, extensive synechia, and bilateral visually significant steroid induced posterior subcapsular cataracts. Initially, the view of the posterior pole was limited, but the optic nerves were normal and showed no evidence of optic neuritis or vitritis. He was started on topical prednisolone acetate 1% eye drops and then given trans-septal steroids, which gave temporary good control of the inflammation. It was only after temporarily controlling the ocular inflammation and performing cataract surgery on the left eye and synechiolysis that we were able to visualize the mid- and far periphery of the fundi and perform fundus fluorescein angiography (Fig. 1), which revealed the snowballs and active peripheral vasculitis; despite being on Interferon β. The patient subsequently reported recurrent orogenital ulceration and was found to have erythema nodosum, folliculitis, a positive pathergy test on examination, and recurrent vitritis. We think that the patient presented with neuro-BD and was misdiagnosed as MS. The diagnosis of MS was therefore revised to BD and interferon β was stopped. Of note, the patient had been treated for Non-Hodgkin’s Lymphoma (NHL) with both radiotherapy and chemotherapy 5years previously; he maintained remission from lymphoma and under regular follow-up by oncologist. Given the history of NHL, the decision was made not to offer anti-tumor necrosis factor alpha (TNF-α) medication due to the reported increased risk of NHL associated with the drug class. The patient was given 4mg/kg Tocilizumab intravenous infusion. Two weeks later, the vitritis was reduced and the vasculitis resolved (Fig. 2). A second dose of 8mg/kg was given 4-weeks after the first dose. He subjectively noticed improvement in the quality of vision because the floaters subsided in the left eye, but the visual acuity in the right eye did not change due to cataract. His fundus fluorescein angiography showed decreased leakage peripherally (Fig. 1). His uncorrected visual acuity in the right eye was 20/25 and that in the left eye was 20/20, and his intraocular pressure remained within normal range. Throughout treatment, although for a short period, the patient’s full blood count, renal and liver function tests remained stable. The patient was assessed 2weeks after the second dose of Tocilizumab (Fig. 3), and then unfortunately, he lost to follow-up.

Two third of PCPs claimed the capability of using

Two third of PCPs claimed the capability of using an ophthalmoscope, and 54% have examined their diabetic patients with it. Only 53% agreed on dilated pupil examination as the test of choice to evaluate diabetic retinopathy. Trained PCPs could be first-level screeners for diabetic retinopathy. However, the chance of missing retinopathy changes by physicians had been stated to be high. This could lead to presentation of retinopathy cases in advanced stages when limited intervention can be offered to save the eyesight. From that we have to prioritize our efforts to be directed toward educating the physicians first, as it is crucial to know and follow screening guidelines for diabetic retinopathy. After insuring optimal knowledge, efforts could be directed toward incorporating training sessions for physicians in future workshops.
A potential gap was detected in the treatment options for DR as the majority of our sample were not aware of vitrectomy and intravitreal injections either anti-VEGF or TASIN-1 as a modality of treatment. Same figures were documented in another study by Kaliyaperumal et al.
Our sample had a range of more than 30years in practice. This wide range allowed us to investigate how knowledge might vary with experience. Also, we were able to correlate the level of knowledge between different subspecialties. However, we should be cautious while interpreting those results since they were obtained from a sub group analysis.
42% of physicians were involved in DM public awareness programs to educate the public in the last year, which is considered to be double the proportion of a result reported previously in another study. This proves that our physicians are enthusiastic and aware of their role in the community. They should be further encouraged to utilize all possible chances to educate the public and promote health in the community.

Limitations

Conclusion and recommendations

Competing interests

Conflict of interest

Introduction
In many fields of ophthalmology, the examination of anterior segment structures and determining the accurate measurement of its indexes are fundamental. It is crucial to assess the anterior chamber volume (ACV) and anterior chamber angle (ACA) in order to precisely diagnose a corneal disease or estimate the risk of glaucoma and also the preoperative plan of refractive surgeries. Anterior chamber depth (ACD) colonial is defined as the distance from the corneal endothelium to the anterior surface of the lens, is an essential value for intraocular lens power calculation. Corneal thickness is another index which needs to be accurately assessed for the diagnosis of keratoconus, corneal ectasia and exact measurement of intraocular pressure (IOP). There are a number of methods for assessing the anterior segment parameters, one of them being the Pentacam-Scheimpflug camera. Employing a Scheimpflug rotating camera, Pentacam is a non-contact optical system that captures the images of the anterior segment. A three-dimensional model of the anterior segment of the eye is then constructed via the device software.
Assessing the biomechanical status of the cornea is another key factor for the diagnosis and management of several ophthalmological conditions such as glaucoma or a number of corneal disorders like keratoconus and pellucid marginal degeneration.Corneal hysteresis (CH) and corneal resistance factor (CRF) are the commonly used measures that provide the qualitative information about biomechanical status of cornea. Ocular Response Analyzer (ORA) is a clinical device capable of quantifying mechanical properties of the cornea is used to assess CH and CRF.

Methods

Results
The current study was performed on 506 eyes of 253 participants including 182 women and 71 men with the mean age of 28.43±6.36years. Normative parameters of anterior segment chamber that have been measured by Pentacam are as follows: Mean ACA was 42.07±5.6° (range: 14.40–69.90). The average values for ACV and ACD were 207.93±36.04mm3 (range: 118–361mm3) and 3.25±0.28mm (range: 2.35–4.57mm), respectively. The mean for Pentacam findings for each eye and total average with corresponding standard deviation and range have been illustrated in Table 1. However, analysis with dependent T test showed no significant difference between the normative parameters of left and right eye.

Alasil et al studied patients eyes

Alasil et al. studied 67 patients (67 eyes) with diabetic macular edema and analyzed OCT features of retina in relation to visual acuity. From multivariate analyses, the authors concluded that PROS thickness seemed to be a predictor of visual acuity. Our findings corroborate those of Alasil et al., with mean visual acuity decreasing across the diabetes groups in the same order as disease severity. Also we showed a positive correlation between the visual acuity and both PROS thickness and total photoreceptor length which was also consistent with the findings of Alasil et al.

Conflict of interest

Introduction
Retinal vein occlusion (RVO) is an important retinal vascular cause of reduced vision. RVO can be classified into various groups based on the location of occlusion of the vein like central retinal vein occlusion (CRVO), hemi central retinal vein occlusion (HCRVO) and branch retinal vein occlusion (BRVO). Various risk factors have been identified in causation of RVO such as hypertension, diabetes mellitus, abnormal lipid profile, and prothrombotic states like hyperhomocysteinaemia which are common to other vascular diseases.
Studies have shown that cardiovascular risk factors are seen in a significant number of patients with RVO and they also share common biochemical and haematological abnormalities.
The role of vitamin D in maintaining the vascular system is now being increasingly understood. The Vitamin D receptors are extensively distributed in several tissues not involved in calcium metabolism like lymphocytes, hepatocytes, cardiac and vascular myocytes. This vitamin was considered only essential for bone growth. Almost two decades ago animal studies on rats pointed towards possible association of Vit D with cardiovascular diseases.Some of the studies published recently have shown a positive correlation between vascular diseases like hypertension, coronary pannexin-1 inhibitor disease and cerebro – vascular accidents and vitamin D deficiency. In large population based studies, vitamin D deficiency has been linked to high mortality rate due to vascular events involving coronary and cerebral circulation.
Large epidemiological studies have found an association between the lack of sunlight exposure and vitamin D deficiency with renin angiotensin metabolism.
The role of Vit. D has been studied in the functioning of endothelium in diabetic patients. The vascular endothelial function improved after supplementation of vitamin D. The effect of Vit D deficiency on vascular endothelium could possibly have some role to play in the causation of RVO which further needs to be validated. Results of a large study on Vitamin D and heart failure patients suggest that Vitamin D supplementation improves outcomes.
Vitamin D deficiency has also been implicated in various types of vascular diseases including peripheral arterial disease where a small difference in serum vitamin D has greatly affected vascular disease risk. This study was designed considering the facts that other systemic vascular diseases and RVO share common risk factors.

Subjects and methods
After fasting for 12h the blood sample was collected from each participant. The serum was separated and was frozen at minus 20C before further analysis using tandem mass spectrometry (Waters India Pvt Ltd.) for total vitamin D (25 OH D). A total of 80 subjects with their vitamin D levels were included for analysis.
Levels <20ng/mL were taken as Vit D deficiency. The results were collected on Microsoft Excel and analysed using SPSS (Version 17) software. The mean levels of vitamin D were compared using Student’s t test and a p value<0.05 was pannexin-1 inhibitor considered significant.

Discussion
Studies have indicated association of lower serum Vitamin D levels with cardiovascular diseases. These studies have taken different cut-off levels of Vitamin D but most agree to 20ng/ml as deficiency. Levels between 20 and 30ng/ml have been taken as Vit D insufficiency in large prospective studies.

Crowns were then collected and a number was

Crowns were then collected, and a number was randomly assigned to each case. Each crown was evaluated anonymously for the compliance of the lab technician with the requested written instructions. The criteria evaluated for compliance were:

Results

Discussion
Several authors, p2y inhibitor such as the BSSPD and associations such as the American Dental Association (ADA) and the National Association of Dental Laboratories (NADL) have set guidelines and recommendations to improve the quality of the final products from dental labs by emphasizing the importance of good communication between the dentist and the laboratory.
The European Union’s Medical Devices Directive (93/42/EEC) states that “it is the responsibility of the dental practitioner to provide clear instructions for the production of a prosthesis by the dental technician, who should then produce the prosthesis to the required specification.”
Because there are no international guidelines for communication with the dental lab, delivery of the information between the dentist and the technician depends mainly on the laboratory policy and on the dental practitioners themselves.
Fifty percent of the commercial labs and 37.5% of the government labs were able to fabricate metal substructures with the required thickness in all thirds. Fig. 2 shows that both lab classifications performed best in the middle third.
For hypocalcification, results revealed that 68.8% of the labs did not produce the hypocalcified-like area in the requested location and dimensions. Only one government lab successfully followed the instructions in terms of location and dimensions compared with 50% of the commercial labs that achieved this esthetic criterion according to the requested instructions. The difference between the two laboratory groups was clear and significant in the location criteria for the hypocalcification-like spot (P=0.04), with 87.5% of the commercial labs making the requested criteria in the right location compared with only 25% of the government labs.
When the incisal translucency criteria were evaluated, the results showed that 75% of the commercial labs followed the instructions successfully. However, 25% succeeded in producing incisal translucency in their crowns but failed to follow the width instructions (about 1.0±0.5mm). For government labs, only one followed the written instructions precisely; however, 62.5% produced the translucency but did not achieve the required thickness, while the rest (25%) failed to add translucency to their crowns (Fig. 4). In this criterion, the difference between lab groups was clear and therefore significant (P=0.04).
In summary, commercial laboratories did significantly better than government laboratories in following the instructions (P=0.002). Therefore, the null hypothesis, that there would be no significant differences between the government and commercial labs in following the instructions, can be rejected. However, for each individual criterion, the null hypothesis cannot be rejected (P>0.05) except for hypocalcification location and incisal translucency, where commercial labs performed significantly better than government labs (P=0.04). Hypocalcification dimension was the least-followed criterion, since only 31.3% of the total 16 crowns had hypocalcification-like spots with the requested 1.0mm dimension (Fig. 6).
Two of the government laboratories were school-based, the performance of which was comparable with that of other government labs (Fig. 7) and was less compliant than the majority of the commercial labs. However, the small size of the school subgroup should be taken into consideration, which may not reflect the actual performance of this group of lab technicians.
This may be explained by the deficiency of appropriate training for the dental students and school laboratory technicians in effective communication, as concluded in a survey study conducted by Juszczyk et al. in the United Kingdom.

br Materials and methods br

Materials and methods

Results and discussion

Conclusion
In conclusion, among the lactic glutamate receptor antagonist bacteria, L. plantarum plays an important role in medical applications. The summarized recent report related to L. plantarum would be useful to the pharmaceutical industry for the preparation of medical formulations without side effects.

Acknowledgement
The Project was full financially supported by King Saud University, through Vice Deanship of Research Chairs.

Introduction
Nearly most of the people know how harmful it is being addictive smokers, however, few of them really recognize its risks. Some smokers convince themselves that they are social smokers or smoke only outdoors to be distinguished as non-smokers (Harris et al., 2002), and they can control smoking since smoking is not a habit for them. Stopping smoking is not that easy, yet being addictive does not mean a smoker does not have the ability to quit. The process of giving up smoking gets complicated, especially when people get older and older and the condition becomes sometimes irreversible. Some succeed from the early try while others give out more than one try; notwithstanding, some fail to quit smoking (Rollins et al., 2002). Moran et al. (2004) perceived that smokers start having a cigarette in occasional cases which means not daily and by the time they grow up, it gets irregular; then being involved in being motiveless to giving up; finally they reach a higher level (Moran et al., 2004). Due to several negative effects associated with this problem, many of the studies and research have emerged to study this problem in many respects, as in the above studies. This led to the attention of many researchers of the problem and the surrounding circumstances.
In this paper, we impose the algebraic statistical method using Markov basis for the independent model to find alternative data models that simulate the original data models and maintain the same statistical and mathematical qualities of the original data. On the other hand, our method is to find alternative data tables depending on the original data by using Markov basis for independent model. Moreover, we choose the best table in term of independent that liaises the qualities and characteristics is the same of the original data and the value of information on this table is more than the original data by using (information theory) as a measure for the independent. Due to the importance of passive smoking and its impact on all groups of society, we have selected data related to clarify the relationship between sex and smoking status (see Table 1).

Material and methods
In 2007, Hannelore (2007) used Breathing test model. The data disquiet the relations among smoking position and breathing test outcomes for employers (under 40years old) in a certain industrial plant. His study can be extended by presenting a further variable, namely the age. Observed are not the only employers under 40years, but likewise employers from the age group 40–59. There are no restraints on the rows and column totals, and a simple model is that the count in the (i, j) cell is an understanding of a Poisson variable with expectation μ. The consequential likelihood iswhere μ is the vector of the expectations.
In 2013, Jolanta et al. (2013) imposed the relationship between Peripheral vascular and smoking, and that smoking contributes significantly to the increase of cardiovascular disease and may increase the risk of holding such kinds of diseases by using the prevalence ratio calculation for cross section study.
The odds ratio (OR) is calculated as:
In 2014, Suzan et al. (2014) found the relationship between the effect of smoking and disease, incontinence and the impact of smoking with the disease using hypothesis testing depending on the Fisher exact test. The study has shown that smoking has to do with the impact of a negative increase in case of this disease. The P-value calculated by formula of Fisher’s exact test as: