[Combined transpupillary thermotherapy with subtenon triamcinolone injection in treatment of choroidal neovascularization secondary to exudative age related macular degeneration]

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

[Evaluation of correlation between severity of dry eye syndrome and retinopathy in patients with diabetes mellitus]

Diabetes is one of the most common systemic diseases. Dry eye syndrome is one of the eye involvements in diabetic patient. Evaluation of correlation between dry eye syndrome and diabetic retinopathy in patients with insipidus diabetes was the aim of this study. In this study two hundred eyes from 100 diabetic patients [non-insulin dependent] were selected and evaluated for dry eye syndrome. The patients then were divided into four groups: group 1: patients without diabetic retinopathy group 2: patients with non-proliferative diabetic retinopathy; group 3: patients with proliferative diabetic retinopathy; group 4: patients with proliferative diabetic retinopathy undergone PRPAll. The patients were examined for Schirmer test, BUT, painting cornea with flourecein and then allocated in different group based on the severity of dry eye. Collected data were analyzed by X2 and Kendle-taue tests using SPSS software. Prevalence of dry eye syndrome in patients in group 1 was 48% and in patients in group 2, 3 and 4 was 52%, 60% and 80% respectively. Dry eye syndrome is a complication of diabetes mellitus and its severity correlates with severity of diabetic retinopathy

[Pupil dilation with intracameral lidocaine during phacoemulsification]

To evaluate pupil dilation with intracameral injection of preservative-free lidocaine 1% during phacoemulsification. This interventional case series included 31 consecutive senile cataract patients scheduled for phacoemulsification and intraocular lens [IOL] implantation. Pupil dilation was achieved using intracameral preservative-free lidocaine 1% without any preoperative or intraoperative mydriatics. Pupil diameter was measured by calipers immediately before and 90 seconds after intracameral injection of lidocaine. Patients included 16 male and 15 female subjects with mean age of 67.3 +/- 9.9 years. Four patients were diabetic and four cases had pseudoexfoliation. Pupil diameter increased from 2.63 +/- 0.3 mm preoperatively to 7.03 +/- 0.61 mm 90 seconds after intracameral injection of lidocaine with a mean increase of 4.39 +/- 0.53 mm [range 3.4-5.2, P<0.001]. Mean post-injection mydriasis was significantly greater in patients without pseudoexfoliation [7.1 mm vs 6.00 mm, independent t test and Mann-Whitney test, P<0.01]. There was no significant difference between diabetic and nondiabetic patients regarding of pre- and post-injection diameter of the pupil. Intracameral preservative-free lidocaine 1% provides rapid and effective mydriasis and can be a safe alternative to other topical and intracameral mydriatics used in phacoemulsification

Primary in tcaocular lens implantation visual results

Visual acuity results at one year follow-up in 195 patients with primary in traocular lens implantation [lOLl] are presented. From 186 eyes with extracapsular cataract extraction and posterior chamber lOLl, 94.62% have visual acuity of 20/40 or more. Eyes with posterior chamber IOL have better visual acuity [94.62%] than anterior chamber IOL [88.88%]. Elderly patients have a 92.5% chance of visual recovery due to macular degeneration. Poor prognosis for improved visual acuity [88.6%] in young patients is mainly due to posterior capsular opacity, which is curable

Proliferative vitreoretinopathy and retinal detachment: surgical results with scleral buckling

This is a prospective study of 127 cases of retinal detachment with different stages of PVR, and evaluates the efficacy of scleral buckling alone in the treatment of rhegmatogenous retinal detachment with different stages of PVR. The overall anatomic success rate, after at least six months of follow-up was 65.3%. The anatomic success rate depends on two important factors: 1] severity of PVR: the success rate decreased with increasing severity of PVR. 2] size of break: reattachment rate was higher for eyes with smaller breaks than for eyes with larger breaks and was least when no break was found. 90.3% of the cases achieved a visual acuity of counting fingers or better. Prognosis for visual improvement after successful scleral buckling was unrelated to the preoperative severity of PVR. None of the anatomically successful cases had a final visual acuity of no light perception. The overall prognosis for phakic patients was better than for aphakics. The difference in success rate, between those treated with implant was not significant. High myopia did not influence the overall anatomic success rate. Cases of giant tear and dialysis were treated successfully by scleral buckling alone with excellent follow-up [83.3%] results