[Intravitreal bevacizumab [avastin] injection alone or combined with triamcinolone versus macular photocoagulation as primary treatment for diabetic macular edema; an interim analysis]

To report the efficacy of a single intravitreal injection of bevacizumab [IVB] alone or in combination with intravitreal triamcinolone acetonide [IVT] versus macular laser photocoagulation [MPC] as primary treatment for diabetic macular edema [DME]. This randomized three-arm clinical trial included 103 eyes of 97 patients with clinically significant DME and no previous treatment. The eyes were randomly assigned to one of the three study arms: the IVB group received 1.25 mg IVB [37 eyes], the IVB/IVT group received 1.25 mg IVB together with 2 mg IVT [33 eyes], and the MPC group underwent focal or modified grid laser photocoagulation [33 eyes]. Primary outcome measure was change in best-corrected visual acuity [BCVA]. Changes in BCVA [logMAR] at 12 weeks were -0.22 +/- 0.23, -0.13 +/- 0.31 and +0.08 +/- 0.31 in the IVB, IVB/IVT and MPC groups, respectively. The marginal regression model based on generalized estimating equation analysis demonstrated that changes in visual acuity was statistically significant in the IVB group at both 6 [P<0.001] and 12 [P=0.024] weeks but only at 6 weeks in the IVB/IVT group. Significant decrease in central macular thickness [CMT] was observed in the IVB and IVB/IVT groups at 6 weeks. Up to 12 weeks, IVB treatment in eyes with DME yielded better visual outcome than laser photocoagulation, although it was not associated with a significant decrease in CMT. IVT seemed to have no further beneficial effect in combination with IVB

[Vitrectomy with internal limiting membrane peeling in acute central retinal vein occlusion presenting with low vision]

To evaluate the visual and anatomical outcomes of pars plana vitrectomy and indocyanine green [ICG] assisted internal limiting membrane [ILM] peeling in fresh central retinal vein occlusion [CRVO] with primary low vision. In a prospective interventional case series, 15 eyes of 15 patients with fresh CRVO [less than 3 months' duration] and presenting best-corrected visual acuity [BCVA] less than 20/200, underwent standard 3-port pars plana vitrectomy and ICG assisted ILM peeling. BCVA and central macular thickness [CMT] by optical coherence tomography [OCT] were evaluated 2 weeks and 1, 2, 4 and 6 months postoperatively and when needed thereafter. The patients included 8 male and 7 female subjects with mean age of 54.7 +/- 11.9 [range 29-75] years. Mean duration of symptoms at the time of surgery was 51.7 +/- 17.8 [range 26-85] days. CRVO was ischemic in 12 eyes [80%] and non-ischemic in 3 eyes [20%]. Patients were followed for 9.5 +/- 4.8 [range 6-23] months. Mean BCVA [logMAR] was 1.86 +/- 0.37 at presentation which improved to 1.65 +/- 0.40 at 2 weeks [P=0.23], 1.68 +/- 0.39 at one month [P=0.095], 1.60 +/- 0.46 at 2 months [P=0.069], 1.72 +/- 0.72 at 4 months [P=0.423], 1.58 +/- 0.69 at 6 months [P=0.140] and 1.42 +/- 0.37 at last visit [P=0.006]. Mean CMT was 605.5 +/- 279.2 +/- m preoperatively which was decreased to 527.4 +/- 274.3 microm at 2 weeks [P=0.371], 624.4 +/- 336.7 microm at one month [P=0.773], 546.4 +/- 344.9 microm at 2 months [P= 0.491], 343.3 +/- 256.9 microm at 4 months [P=0.250], 369.3 +/- 207.5 microm at 6 months [P=0.078] and 368.9 +/- 199.0 microm at final visit [P=0.03]. Pars plana vitrectomy with ILM peeling in patients with fresh CRVO and low presenting visual acuity [<20/200] may improve visual acuity and decrease in CMT in long-term follow-up, but does not seem to have any significant effect in comparison to the natural course of CRVO. Certain postoperative complications such as vitreous hemorrhage are relatively common requiring repeat vitreoretinal surgery. Therefore, we do not recommend this procedure for such patients

[Evaluation of safety devices used in work-related eye injuries]

To report and evaluate the characteristics of patients referred to the emergency department of Labbafinejad Medical Center with work-related eye injuries during 2005. In this descriptive study, an available sample of patients with work-related eye injures were assessed. Demographic characteristics, causes of ocular trauma, and use of work safety devices were main evaluated variables. Overall, 99 subjects [96% male] with mean age of 31.76?10.55 years were enrolled. Mean time interval between the accident and referral to eye emergency was 2.46 +/- 4.46 days [0-30 days]. Of these, 66.6% came to the emergency ward on the first day after the incident and 37.1% underwent an eye examination at this center for the first time. The most unsafe activities were grinding [21.4%], welding [20.4%], hammering work [14.3%] and manual work [10.2%]. Metal industrial [50%], constructional [17.3%] and mechanical [8.2%] workers had the highest risk for eye injury among different occupations. The major consequence of eye injuries was corneal foreign bodies [72.7%]. Of injured patients, only 14 persons [14.1%] had passed job safety educational courses and 93 persons [93.9%] had not used any eye protection device. Most injured patients were young men workers using no safety devices; therefore it seems that occupational safety efforts including eye protection education and training programs in this context is insufficient

Causes and results of vitrectomy for spontaneous non-diabetic vitreous hemorrhage

To determine the visual and anatomical outcomes and complications of vitrectomy for non-traumatic non-diabetic vitreous hemorrhage [NDVH] and to report the causes of the condition among patients at Labbafinejad Medical Center, Tehran-Iran, from 1993 to 2003. Records of patients who underwent vitrectomy for non-traumatic NDVH with 6 months follow up were reviewed for demographic characteristics, causes of NDVH and results of surgery. Fifty eyes [54.2% right eyes] of 49 patients [51% male] with mean age of 62.7 +/- 10.3 years were enrolled in the study. Mean visual acuity [VA] was 2.36 +/- 0.52 LogMAR and relative afferent pupillary defect [RAPD] was positive in 91.7% of the eyes, preoperatively. Causes of non-traumatic NDVH detected intraoperatively were: branch retinal vein occlusion [56%], central retinal vein occlusion [16%], choroidal neovascularization [12%], and posterior vitreous detachment with break, Eales disease, familial exudative vitreoretinopathy, and Terson syndrome [each in 4%]. Mean VA increased significantly at 6th month [1.38 +/- 0.72 IogMAR] compared to preoperative value. [P<0.0001] The most common causes of decreased VA were: macular pigmentary derangement [26%], optic atrophy [16%], severe lens opacity [12%], and epiretinal membrane [8%]. Despite the statistically significant increase in mean VA following vitrectomy, underlying macular pathology limits significant improvement of central VA in most cases of non-traumatic NDVH

Clinical aspects and results of lensectomy in hereditary lens subluxation

To evaluate the clinical manifestations and results of lensectomy in patients with hereditary lens subluxation at Labbafinejad Medical Center, Tehran-Iran from 1996 to 2003. In an interventional case series, records of patients with hereditary lens subluxation who had undergone lensectomy were reviewed. Patients with at least 6 months of follow up were included. Background disease, best corrected visual acuity [BCVA] before and after surgery, intraocular pressure [IOP], and post-operative refraction and complications were evaluated. The study was performed on 87 eyes of 49 patients including 27 male and 22 female subjects. Mean follow up was 20 +/- 18 months. Marfan syndrome [79.5%], Weill-Marchesani syndrome [8.2%], simple ectopia lentis [8.2%], and homocystinuria [4.1%]. The most common indication for surgery was non-correctable refractive error [92.1%]. Mean BCVA was 1.13 LogMAR preoperatively which improved to 0.26 Log MAR post-operatively [P< 0.001]. BCVA better than 20/40 was achieved in 82.8% of cases after surgery. Angle-supported anterior chamber intraocular lens [AC IOL] was implanted in 85.1% of the eyes. Prophylactic band was applied in 63 eyes [72.4%]. Retinal detachment developed in four eyes, which was successfully treated. Lensectomy with implantation of angle-supported AC IOL in patients with hereditary subluxated lens will improve vision significantly without significant complications

Results of vitrectomy in idiopathic Macular Hole

To evaluate the visual and anatomical outcomes and complications of vitrectomy with or without removal of internal limiting membrane [ILM] in idiopathic macular hole [IMH] at Labbafinejad Medical Center, Tehran-Iran, 1993-2003. Hospital records of patients who had undergone vitrectomy for IMH and completed 6 months of follow up were reviewed for demographic data and outcomes of surgery .The study was conducted on 30 eyes [46.7% right eyes] of 29 patients [69% female] with mean age of 65.2 +/- 5.6 years. Mean duration of symptoms was 3.2 +/- 3.7 months [66.7% less than 6 months]. Preoperatively macular holes were in stages 2, 3, and 4 in 3.0%, 36.7%, and 33.3%, respectively. ILM removal was performed in 21 eyes [70%]. Mean visual acuity was 099 +/- 0.6 LogMAR preoperatively which reached to 0.87 +/- 0.39 LogMAR postoperatively [P=0.05]. Single operation anatomical success rate was 80% [24 eyes] and final success rate was 86.7% [26 eyes]. Retinal breaks developed in 3 eyes [10%] intraoperatively. ILM removal had no effect on increasing the rate of macular hole closure. ILM removal has no significant role on closure of IMH with less than 6 months of duration

[Agreement between quantitative analysis of fundus and angiographic images by Photoshop software and clinical judgment]

To evaluate the agreement between a new method for quantitative analysis of fundus or angiographic images using Photoshop software and clinical judgment. Four hundred evaluated by three retina variables were selected for eighteen fundus and angiographic images of diabetic patients were specialists and then by computer using Photoshop 7.0 software. Four amount of hard exudates [HE] on color pictures, amount of HE on red-free pictures, severity of leakage, and size of foveal avascular zone. Available programs in the software such as color selection, luminosity channel, and histogram and tools such as magnetic lasso and magic wand were used for measurement. Coefficients of agreement and kappa measurements were calculated. Agreement [kappa] between the two methods in the amount of HE on color and red-free photographs were 85% [0.69] and 79% [0.59], respectively. This agreement for severity of leakage was 72% [0.46]. In the evaluation of the foveal avascular zone size with two methods of quantification using the magic and lasso software tools the agreement was 54% [0.09] and 89% [0.77], respectively. Quantitative measurement of fundus and angiographic image variables such as HE, leakage, and foveal avascular zone can be performed precisely using Photoshop software

[Effect of levodopa-carbidopa on visual function in patients with recent nonarteritic anterior ischemic optic neuropathy]

To evaluate the effect of levodopa-carbidopa on improvement of visual acuity, color vision, and visual field in patients with nonarteritic anterior ischemic optic neuropathy [NAION] with onset less than 6 wks. In this double-blind randomized controlled trial, 13 patients were treated with levodopa-carbidopa and 12 patients were treated with placebo for 3 weeks. After 6 months, visual acuity [evaluated by Snellen chart], color vision [evaluated by Ishihara pseudoisochromatic plate], and visual field [evaluated by Humphrey automated perimetry central 30-2] were evaluated. Mean visual acuity in the treatment group was 1.007 LogMAR [1/10] at beginning of study and 0.75 LogMAR [4/10] at the end. Improvement of visual acuity in this group was 3 lines of Snellen chart [P=0.001]. In the placebo group, mean visual acuity was 0.85 LogMAR [3/10] at the beginning of study and 0.75 LogMAR[4/10] at the end. Improvement of visual acuity in this group was 1 line of Snellen chart [P=0.013]. Mean color vision in treated eyes was 4/14 at beginning of study and 5.76/14 at the end. In the placebo group this value was 4.3/14 at ending. There was no statistically significant difference in color vision between two groups both at beginning and at the end of treatment. Visual field improvement did not show any difference between the two groups [P=0.93]. Although levodopa-carbidopa significantly improved visual acuity, other aspects of visual function did not show significant changes. Other therapeutic modalities should be tired

[Vitrectomy in giant retinal tear: anatomic results and influencing factors]

To evaluate the success rate of vitrectomy in giant retinal tears [GTR] and factors influencing it. In an interventional case series, hospital records of 68 eyes of 63 patients operated for GRT were reviewed. Standard three port vitrectomy plus placement of an encircling band, retinopexy, and internal tamponade was performed for all eyes. Possible influencing factors including age, sex, visual acuity, afferent pupillary defect, grade of PVR, size and location of GRT, macular status, extent of RD, interval from onset of symptoms to operation, co-existing eye diseases, surgical technique, post-operative complications, and results after silicone oil removal were evaluated. Anatomic success was classified as complete success, relative success, and failure. Mean age of the patients was 31.2+]-17.2 and 50 patients [79.3%] were male. Underlying ocular disease existed in 39 eyes, of which high myopia was the most prevalent [33.8%]. The eyes were operated after a mean of 30 days from beginning of symptoms. Silicone oil was used for internal tamponase in 64 eyes and was removed from 36 eyes. Patients were followed from 1 to 54.5 months [median 10 months]. Anatomic success rate was 73.7%. Preoperative stage of PVR was the only factor found to be associated with worse anatomic results. Anatomic success rate was comparable to that of other centers and significantly better than results of a previous from our center. Early operation of eyes with GRT before development of PVR results in better anatomic success

[Effect of oral prednisolone on visual outcomes and complications after scleral buckling]

To evaluate the effect of oral prednisolone on visual outcome and complications of scleral buckling [SB] in patients with rhegmatogenous retinal detachment [RRD]. In a randomized double-blind placebo-controlled trial, patients with acute RRD who underwent SB were randomly divided into two groups. Oral prednisolone was administered for the treatment group and placebo for the control group. The two groups were compared for visual acuity [VA] , retinal detachment [RD], cystoid macular edema [CME], and proliferative vitreoretinopathy [PVR]. The trial was performed on 25 patients in the treatment group and 27 patients in the placebo group. Mean preoperative VA [LogMAR] was 1.46 +/- 0.81 overall, including 0.85 +/- 0.62 in location were equal in both group. [P=0.45] Significant PVR was seen in one eye in the treatment group and 3 eyes in the placebo group. [P=0.39]. Postoperative oral prednisolone does not seem to affect visual outcomes and complications of scleral buckling in phakic patients

Therapeutic effects of laser photocoagulation and vitrectomy in Eales' disease

Eales' disease is an idiopathic obliterative retinal vasculopathy that is treated with laser photocoagulation, and/or vitrectomy. In order to determine visual outcomes and regression of retinal neovascularization following scattered peripheral retinal photocoagulation, and/or vitrectomy in cases with Eales' disease, we did a retrospective study of the records of these patients treated in Labbafinejad Medical Center from 1988 to 1998. We studied the existing data of 67 eyes of 54 patients with complicated Eales' disease who had undergone laser photocoagulation and/or vitrectomy based on their clinical presentations. Our main outcome measure was the visual acuity changes of the eyes following treatment. In 43 eyes, scattered peripheral retinal photocoagulation alone led to complete regression of neovascularization and a VA of 20/30 was obtained in 60.4%. Vitrectomy was finally required in 24 eyes and of these, 37.5% gained a VA of 20/ 30. Although scattered peripheral retinal photocoagulation should be the first line of treatment in Eales' disease, it may not always produce regression of retinal neovascularization. In such cases vitrectomy may further enhance therapeutic success