Razi Journal of Medical Sciences

  Background & Aim: Refractive change after strabismus surgery is a known phenomenon which may be attributed to the extraocular muscle traction.Since previous studies were often done by conventional methods,accompanied by a short follow-up, and without considering simultaneous evaluation of both refractive and topographic changes, this study was organized to evaluate refractive and topographic changes after strabismus surgery by hangback method.

  Patients and Method : In this prospective, interventional,and case series study, 53 eyes of 33 patients undergoing hangback strabismus surgery were studied. Cyclorefraction with autorefractometer and topographic evaluation were done before and 2 weeks, 2 months, and 6 months after the operation. Data were analyzed by SPSS software version 15 using t- test and Chi-square test.

  Results :The mean age of the subjects was 17.7 ± 10.2 years. We performed medial rectus recession on 18 eyes, lateral rectus recession on other 18 eyes, and simultaneous recession-resection on the remaining cases. In comparison to preoperative astigmatism, mean surgically induced astigmatism evaluated by cyclorefraction 2 weeks, 2 months, and 6 months postoperatively was 0.17± 0.52, 0.35±0.62 and 0.11±0.27 diopters ,respectively. The overall axis shift was toward 180 (2, 24, and 15 degrees respectively)(in all cases p<0.05). Mean surgically induced astigmatism evaluated by topographic data was 16±0.97, 0.53±1.2, and 0.29±0.63 diopters (in all cases p<0.05). The overall flat meridional shift was toward 180 (30, 25, and 7 degrees respectively). Comparing astigmatic changes in topography with those in cyclorefraction revealed a statistically significant difference in the second week measurements and not in other measurement times.

  Conclusion: Hangback surgery can induce refractive changes and astigmatism, which may be due to corneal changes. Surgically induced changes reach a maximum amount in 2 months, and despite shifting toward baseline, will persist for 6 months.

Background: Gestational Trophoblastic Neoplasia (GTN) is the malignant form of gestational trophoblastic disease that has different capabilities in metastasis and invasion stance. Therefore, the aim of this study was to identify an appropriate and applicable longitudinal marker, using the serum human chorionic gonadotropin (hCG) levels during 21 days after mole evacuation for predicting the gestational trophoblastic neoplasia in women with molar pregnancy.

Methods: In the present retrospective study, documents of 201 patients with hydatidiform mole, according to their pathological reports, who from 2003 to 2013 referred to the educational and health care centers affiliated to Shahid Beheshti University of Medical Sciences were investigated. A two-stage shared random effects model was used to assess the relationship between repeated measures of β-hCG concentration (as the longitudinal marker) and occurrence of GTN. To determine the power of repeated β-hCG values for predicting GTN, a receiver operating characteristic (ROC) curve was applied in the statistical software R version 2.15.3.

Results: In a total sample of 201 patients, 171 cases (85.1%) had spontaneous remission and GTN was detected in 30 cases (14.9%). Our modeling approach showed that the repeated measures of β-hCG concentration (in weeks 0, 1, 2 and 3) can correctly classify about 86.7% of patients with GTN and 83.0% of patients without GTN. The estimated area under curve (AUC) was 91.2%.

Conclusion: Our findings revealed that the repeated measures of β-hCG concentration have a high predictive accuracy for early detection of GTN. Thus, for women who suffered from molar pregnancy, monitoring the three-week trend of this marker is recommended for early detection of this malignancy.