Summary: Aims: This open‐label prospective phase I/IIa clinical study used autologous bone marrow‐derived mesenchymal stromal cells (BM‐MSCs) followed by mesenchymal stromal cells conditioned media (MSC‐CM) for the first time to treat multiple sclerosis (MS) patients. The primary goal was to assess the safety and feasibility and the secondary was efficacy. The correlation between the MSC‐CM content and treatment outcome was investigated.Methods: Ten MS patients who failed conventional therapy were enrolled. Adverse events were recorded to assess safety. The Expanded Disability Status Scale (EDSS) was the primary efficacy measurement, the secondary included clinical (25WFT, 9‐PHT), cognitive (MMS), ophthalmology (OCT, VEP), and radiological (MRI lesion and volume) tests. The MSCs‐CM concentration of 27 inflammatory biomarkers was investigated.Results: The treatment protocol was well tolerated by patients. There was an overall trend of improvement in all the tests, except the lesion volume which increased significantly. A decrease of 4 and 3.5 points on the EDSS was achieved in two patients. We report a correlation between a decreased lesion number at baseline and higher IL‐6, IL‐8, and VEGF MSC‐CM content.Conclusion: The used protocol was safe and feasible with possible efficacy. The addition of MSC‐CM could be related to the magnitude of EDSS improvement observed.

Purpose: Intrastromal corneal ring segments (ICRSs) are small arc-like implants that are being used increasingly as a minimally invasive treatment for patients with keratoconus. This study assessed the effectiveness of KeraRing implants, a type of ICRS, to treat keratoconus. Methods: Retrospective case series descriptive study of 43 patients (55 eyes) with keratoconus who underwent KeraRing implantation from February 2008 to June 2009. Patients who had intraoperative or postoperative complications and/or did not complete at least 6 months of follow-up were excluded. All patients underwent complete ophthalmologic examinations that included measurement of the uncorrected visual acuity (UCVA), best spectacle–corrected visual acuity (BSCVA), manifest refraction, and keratometry before and 2 days, 2 weeks, 1 month, and 3 and 6 months after surgery. The ring segments were chosen based on a nomogram from the manufacturer. Results: Six months postoperatively, the mean UCVA increased significantly (P < 0.05) from 0.10 ± 0.11 to 0.32 ± 0.25 and the mean BSCVA increased from 0.36 ± 0.23 to 0.57 ± 0.24 (P < 0.05). The mean spherical refractive error significantly (P < 0.05) improved from −4.85 ± 2.90 diopters (D) to −1.89 ± 2.68 D, and the mean cylindrical refractive error significantly (P < 0.05) improved from −3.65 ± 1.70 D to −2.60 ± 1.62 D. The mean spherical equivalent significantly (P < 0.05) decreased from −6.68 ± 2.93 D to −3.19 ± 2.75 D, and the mean keratometry value decreased from 51.83 ± 4.14 D to 47.27 ± 3.68 D. The improvement in the UCVA and BSCVA continued over the 6-month postoperative period, but significant changes occurred only during the first 3 months. These changes occurred in patients with all grades of keratoconus. Conclusions: KeraRing implantation provided significant improvement in visual acuity, spherical equivalent, and keratometry results. This ICRS is an effective treatment for managing keratoconus and might delay or even avoid the need for penetrating keratoplasty.

Purpose: To estimate the prevalence of blindness, visual impairment, diabetes, and diabetic retinopathy in north Jordan (Irbid) using the rapid assessment of avoidable blindness and diabetic retinopathy methodology. Methods: A multistage cluster random sampling technique was used to select participants for this survey. A total of 108 clusters were selected using probability proportional to size method while subjects within the clusters were selected using compact segment method. Survey teams moved from house to house in selected segments examining residents 50 years and older until 35 participants were recruited. All eligible people underwent a standardized examination protocol, which included ophthalmic examination and random blood sugar test using digital glucometers (Accu-Chek) in their homes. Diabetic retinopathy among diabetic patients was assessed through dilated fundus examination. Results: A total of 3638 out of the 3780 eligible participants were examined. Age- and sex-adjusted prevalence of blindness, severe visual impairment, and visual impairment with available correction were 1.33% (95% confidence interval [CI] 0.87-1.73), 1.82% (95% CI 1.35-2.25), and 9.49% (95% CI 8.26-10.74), respectively, all higher in women. Untreated cataract and diabetic retinopathy were the major causes of blindness, accounting for 46.7% and 33.2% of total blindness cases, respectively. Glaucoma was the third major cause, accounting for 8.9% of cases. The prevalence of diabetes mellitus was 28.6% (95% CI 26.9-30.3) among the study population and higher in women. The prevalence of any retinopathy among diabetic patients was 48.4%. Conclusions: Cataract and diabetic retinopathy are the 2 major causes of blindness and visual impairment in northern Jordan. For both conditions, women are primarily affected, suggesting possible limitations to access to services. A diabetic retinopathy screening program needs to proactively create sex-sensitive awareness and provide easily accessible screening services with prompt treatment.

: Purpose: To evaluate the risk factors for the development of pterygium in a Middle Eastern country (Jordan) and to compare our findings with those from other countries. Methods: This study was conducted in Irbid District, in northern Jordan, a region located 31 degrees north of the equator, with a stable, subtropical climate. In this case control study, 96 adult subjects presenting with pterygium were interviewed and compared to 192 control subjects who were group‐matched for age and sex. A standard questionnaire and eye examination were completed for both groups. Results: There was a strong positive association between pterygium and environmental factors. The most striking increase in the risk of pterygium occurred in subjects who worked outdoors compared to those who worked indoors, with an odds ratio of 5.47. Current and previous sunlight exposures were associated with a higher risk of developing pterygium, with odds ratios of 3.54 and 4.52, respectively. Previous use of sunglasses represented a protective element, but the protective role of recent use of sunglasses was not statistically significant. Conclusion: There is a statistically significant association between outdoor work, sunlight exposure and pterygium formation. Efforts should be made to educate outdoor workers to wear sunglasses and brimmed hats. Public education should focus on avoidance of unnecessary sunlight exposure.

Purpose: To investigate the prevalence of blindness and visual impairment among a population of Jordanian diabetics. Methods: A total of 986 diabetic patients were fully assessed, including complete history, examination, and laboratory tests. All patients underwent detailed eye examination, which included visual acuity, slit-lamp examination, tonometry, funduscopy, and fundus fluorescein angiography (FFA). Results: Of all patients examined, 53.2% were male and 46.8% were female. The mean age and duration of diabetes were 55.3 and 11.9 years. Of all patients, 93.3% had type 2 while 6.7% had type 1 diabetes mellitus (DM). Over half (50.3%) were on oral hypoglycemic agents, 34% on insulin, and 14.5% on both types of treatment, whereas only 1.2% were on diet alone. The mean value for HbA1c was 7.7%. The prevalence of blindness among participants was found to be 7.4%, while 10.1% were visually impaired. Diabetic retinopathy (DR) was present in 64.1%, 37.8% had cataract, and 8.7% had undergone cataract surgery. Using multivariate logistic regression analysis, visual impairment was significantly associated with age, treatment of diabetes, and DR, while only age and retinopathy were significantly related to blindness. Conclusions: DM is a common disease in Jordan and DR is highly prevalent among Jordanian diabetics. National screening and educational programs are highly needed to reduce the risk of blindness and visual impairment among diabetic patients.