ABSTRACT
To evaluate the effect of trans-scleral cyclophotocoagulation [TSCPC] in reducing intraocular pressure in eyes with history of pars plana vitrectomy with or without intraocular silicone oil and refractory to medical treatment. Medical records of 35 eyes of 35 patients who underwent TSCPC for medically uncontrolled glaucoma after pars plana vitrectomy for retinal pathology were reviewed retrospectively. Diode laser contact TSCPC was performed at a power of 1-3 watt, for a duration of 2 seconds and with 15-30 applications. Intraocular pressure, visual acuity, number of previous operations, number of medications, number of treatment sessions per eye. Laser parameters and complications were evaluated. After a mean follow-up period of 13.31 +/- 4 [range 6-60] months, mean IOP was decreased from 33.46 +/- 9.80 [12-38] mmHg before surgery to 16.57 +/- 8.21 [2-46] mmHg after TSCPC [P<0.001]. The number of anti-glaucoma medications was reduced from 2.60 +/- 1.09 preoperatively to 1.31 +/- 0.99 at final follow up [P<0.001]. Qualified success and complete success were achieved in 29 [83%] and 9 eyes [20%], respectively. Patients with medically uncontrolled intraocular pressure following to pars plana vitrectomy with or without intravitreal silicone oil can be treated successfully with TSCPC
ABSTRACT
To investigate the risk factors of wound dehiscence and lens extrusion following blunt trauma in patients with penetrating keratoplasty [PK] as well as the results of treatment. In a retrospective case series, 7 eyes of 7 patients including 6 male and one female subjects were investigated. All cases received primary care at the time of referral and then underwent secondary repair under general anesthesia in operation room setting. After evaluation of the wound, anterior vitrectomy was performed and secondary wound repair was done using nylon 10-0. Mean age of patients was 20.6 +/- 6.2 [range 10 to 30] years and mean interval between keratoplasty and trauma was 15.6 +/- 10.1 [range 2.5 to 26.5] months. Mean best-corrected visual acuity of patients before the trauma and at final follow-up was 0.6 +/- 0.38 logMAR [20/80] and 0.9 +/- 0.96 logMAR [20/160], respectively. In one case, visual acuity decreased to light perception after the final treatment. No case needed regraft. Most prevalent site of dehiscence was superior to the graft [4 cases] and the most prevalent cause of blunt trauma was hitting by hand. No case of endophthalmitis occurred. PK patients are susceptible to wound dehiscence due to trauma especially during the first postoperative year. This is more prevalent in young male subjects who are more prone to trauma because of higher social activities. Proper explanation of this problem for patients together with using protective eye shields as well as performing lamellar keratoplasty instead of PK if possible can decrease side effects of trauma in these patients
ABSTRACT
To evaluate the outcomes of internal tamponade using heavy silicone oil in complicated retinal detachment [RD] surgery. In this interventional case series, patients with complicated RD involving the inferior retina were enrolled. Inclusion criteria included RD secondary to proliferative vitreoretinopathy [PVR CP6 and/or CA6] involving the inferior retina, inferior or posterior tears, giant tears, penetrating trauma or RD combined with choroidal detachment. Heavy silicone [Oxan HD, Bausch and Lomb, USA] was injected at the end of surgery after peeling of retinal membranes or retinotomy. Follow-up examinations were scheduled one day, one week, one month and four months after surgery. Additional visits were made depending on the condition of the eye. Seventeen eyes of 17 patients with mean age of 45.4 +/- 12.2 [range 19-71] years underwent vitrectomy and heavy silicone oil tamponade. Mean follow-up was 11.4 +/- 3.5 [range 4-16] months. There was total RD in 10 cases, subtotal RD involving the inferior retina in 6 patients and RD associated with choroidal detachment in one. Best-corrected visual acuity [BCVA] before surgery was LP or HM in 13 eyes and counting fingers at 0.5 to 3 m in 4 eyes. During the follow-up period, the retina remained attached in 12 cases [70/5%] but 5 eyes needed further vitrectomy for reattachment. BCVA improved from 1.95 +/- 0.09 LogMAR preoperatively to 1.5 +/- 0.35 four months after the operation [P=0.045]. After 4 months' follow-up BCVA was HM in 4 eyes and 0.5 m to 20/200 in 13 eyes. Transient IOP rise occurred in one eye and silicone oil emulsification was seen in another eye. Heavy silicone oil tamponade had favorable results in terms of anatomical attachment of the retina and visual acuity
ABSTRACT
To determine globe and patient survival in children with retinoblastoma at a major referral center in Iran. Hospital records of 156 eyes of 105 patients with retinoblastoma referred to the Ocular Oncology Center at Rasoul Akram Hospital, Tehran, Iran from 2001 to 2007 were reviewed. Demographic data, family history, presenting symptoms, duration of symptoms, ocular findings and treatment modalities were evaluated. Main outcome measures included patient survival with the event of death, and globe survival with the event of enucleation. Mean age at the time of diagnosis was 28.5 +/- 23.0 [range 3-120] months. Mean follow-up was 30.9 +/- 29.0 [range 3-72] months. Male to female ratio was 47/58. Five patients had positive family history. Involvement was unilateral in 52% and bilateral in 48% of patients. Enucleation was performed as primary treatment in 76 eyes [48.7%] and as secondary treatment for recurrence in 11 eyes [7.1%]. Sixty nine eyes [44.2%] were salvaged by different globe preserving modalities. Kaplan-Meier 5-year survival estimate for globe preservation according to the International Classification of Retinoblastoma [ICRB] was 100% for group A, 93.5% for group B, 86.7% for group C, 57.1% for group D and 0% for group E. Kaplan-Meier estimates for 5-year patient survival was 100% for ICRB groups A and B, 92.3% for group C, 73.3% for group D and 79.9% for group E. Five year patient survival rate was better in ICRB groups A to D than in group E [P=0.004]. Advances in treatment, early diagnosis and prompt referral have improved the prognosis of patients with retinoblastoma in terms of globe and patient survival
ABSTRACT
In spite of several treatment methods which are being used to treat exudative age-related macular degeneration [ARMD] like laser therapy, Intravitreal steroids injections or anti-vascular endothelial growth factors [VEGF], no method has been yet presented as the best treatment way. This study aimed to assess the effectiveness of combined transpupillary thermotherapy [TTT] with subtenon triamcinolone acetonide [TA] injection in treatment of choroidal neovascularization [CNV] in patients with ARMD. In this clinical trial, 63 eyes of 57 patients with CNV secondary to exudative age-related macular degeneration [ARMD] were studied. All CNVs [including 20 predominantly classic and 43 predominantly occult lesions] were treated with diode laser [810nm]. In 20 eyes with predominantly classic CNVs, 20 mg and 40 mg subtenon triamcinolone was injected in 12 and 8 eyes respectively. The patients were followed for a mean of 9.1 months [ranging from 5.5 to 16 months]. The average number of treatment sessions was 1.25. In 43 eyes with occult CNV, 20 mg and 40 mg subtenon triamcinolone was injected in 31 eyes and in 12 eyes respectively. Mean follow up time was 12 months [4.5 to 23 months]. Mean treatment times was 1.17. A variable spot size of 0.8, 1.2, 2 and 3 mm was used depending on the size of CNV; and treatment was given in one area for 1 minute. Thermotherapy was adminstered through a contact lens at a power range between 120-560 mw. At the end of treatment, each patient randomly received 20 mg or 40 mg subtenon triamcinolone acetonide injection in superotemporal quadrant. Outcome was assessed with clinical and angiographic examination collected data were analyzed by one-sample and paired - sample T test, using SPSS software. At the end of the study in first group, visual acuity remained stable [0 to +/- one line] in 14 out of 20 [70%] of eyes, improved [> one line] in 2 of 20 [10%] eyes and showed a decline [> one line worsening] in 4/20 [20%] eyes. In second group thirty one eyes [72.1%] had stable vision [ +/- 1 line], 4 eyes [9.32%] had better vision more than 1 line and 8 eyes [18.6%] had more than 1 line decrease in vision. All CNVs were closed in last follow up. No statistically significant difference was found between two groups in clinical and functional with 20 mg and 40 mg injection of subtenon TA. Combined TTT and subtenon injection of TA in eyes with exudative ARMD can be an effective method to stabilize visual acuity of these patients
Subject(s)
Humans , Triamcinolone Acetonide , Triamcinolone Acetonide/administration & dosage , Hyperthermia, Induced , Pupil , Macular Degeneration , Lasers, Semiconductor , Visual AcuityABSTRACT
To evaluate intermediate-term results of Baerveldt tube implantation for treatment of refractory glaucoma in young patients. We retrospectively studied 14 eyes of 11 consecutive patients aged<20 years with refractory glaucoma who underwent Baerveldt tube implantation after 1 to 3 previous surgical procedures. The glaucoma was congenital in eight eyes and following congenital cataract surgery in four eyes, deep vitrectomy in one eye and post-traumatic in one eye. This study included seven male and four female subjects with mean age of 8.6 +/- 6.3 [range 2-20] years. Mean follow up period was 38 +/- 0.9 months [range 1-4 years]. Mean intraocular pressure [IOP] was 35 +/- 11 mmHg preoperatively which decreased to 16.5 +/- 4.7 mmHg postoperatively [P=0.001]. IOP of 5 to 21 mmHg was achieved in six eyes [42.9%] without antiglaucoma medication and in 12 eyes [85.7%] with or without medication. No loss of light perception or phthisis bulbi occurred during the follow up period. Postoperative interventions included shortening of the tube in one eye [7%], iridectomy at the site of tube due to occlusion by iris in one eye and lens aspiration+PCIOL two years after tube implantation in one eye. Our results show that Baerveldt tube implantation is an effective and safe method for IOP control in young patients with refractory glaucoma