[Local anesthesia in vitreoretinal surgery]

To compare general anesthesia [GA] with local anesthesia [LA] in terms of safety and patient satisfaction. In this interventional case series, 928 consecutive patients who underwent vitreoretinal surgery were included. Data for analysis were type of anesthesia and operation, patient compliance, operating conditions and pain scores. General anesthesia was provided with a standard method and local anesthesia was performed through peribulbar or retrobulbar routes. Selection of the type of anesthesia was determined by patient age and co-morbidities based on the surgeon's opinion. Patients were operated under local anesthesia in 343 [36.9%] and general anesthesia in 585 [63.1%] cases. Mean age was 68.8 +/- 7.3 [range 51-78] years in the LA group and 55.9 +/- 6.5 [range 43-70] years in the GA group [P= 0.041]. ASA [American Society of Anesthetics] physical status score in the LA group was higher than GA group. Patients were in appropriate condition in 96.4% and operating conditions were good or excellent in 98.8%. The majority of patients [97%] said they would choose local anesthesia for their next vitreoretinal procedures. Local anesthesia is a useful and flexible method of anesthesia for vitreoretinal surgery, with excellent patient tolerance, especially in old patients and those who suffer from concurrent diseases

[Nd:YAG membranotomy in diabetic premacular hemorrhage]

To evaluate the success rate of Nd:YAG laser membranotomy in patients with diabetic premacular hemorrhage. This interventional case series included 24 eyes of 22 patients referred to retina clinic of Farabi Eye Hospital, Tehran, Iran during 2000-2007 with chief complaint of sudden loss of vision and clinical diagnosis of premacular hemorrhage due to proliferative diabetic retinopathy. All patients underwent complete ocular examination and color fundus photography. Nd:YAG laser membranotomy was performed in patients with >3 DD hemorrhage. Main outcome measures were success rate of membranotomy, improvement of visual acuity and the complications. Twenty-four eyes of 22 patients [68.2% female and 31.8% male] with diabetic premacular hemorrhage were enrolled. Mean age of patients was 56 +/- 6.5 years. Nd:YAG laser membranotomy was successful in 71% of patients resulting in release of trapped blood into the vitreous cavity which absorbed during 14.3 +/- 5.03 [range 8 to 27] days. Range of preoperative visual acuity was from hand motion to count finger at 4 m which improved to a range of 20/100 to 20/25 postoperatively. Patients complained of some visual disorders such as blurred vision and floater over 23-86 days [mean 43 days], postoperatively. Macular photocoagulation was performed in 11 eyes with macular edema before panretinal photocoagulation. Mean follow-up period was 34.7 +/- 18.3 [range 10-71] months. Nd:YAG laser membranotomy in diabetic premacular hemorrhage is a simple and inexpensive outpatient procedure which results in rapid visual recovery and is relatively safe. Further controlled clinical trials are recommended

Therapeutic effect of macular grid photocoagulation in treatment of nonexudative age-related macular degeneration

To investigate the effect of prophylactic subthreshold laser macular grid photocoagulation on drusen area and to evaluate the visual outcome and incidence of choroidal neovascularization in patients with soft drusen maculopathy. In a nonrandomized nonmasked clinical trial, 18 patients [36eyes] with bilateral soft drusen maculopathy were studied. For each patient, one eye was treated with 48 subthreshold [invisible end-point] applications of 532-nm KTP-laser in a macular grid pattern and the fellow eye was observed. Soft drusen areas were calculated and compared between the two groups at baseline and follow-up visits at 3, 6, 12, and 30 months of therapy. Best corrected visual acuity was also compared in observed and laser-treated eyes. Reduction of drusen area, change in visual acuity, and rate of CNV were assessed in both groups. At baseline, there was no significant difference in the mean drusen surface area between the two groups [P=0.90]. The mean surface area of soft drusen in treated eyes was6.51 mm[2] after 30 months and 7.58 mm[2] [P=0.50] in the control eyes. There was a trend towards reduction in the mean soft drusen area after 30 months from baseline in laser-treated eyes [6.51 vs6.97 mm[2]]. In treated eyes, there was no statistically significant difference between the mean best corrected visual acuity at the baseline [0.28 logMAR] and after 30 months [0.32 logMAR] [P=0.40]. Subthreshold macular grid photocoagulation with 532-nm KTP-laser did not seem to reduce drusen surface area significantly and did not improve best corrected visual acuity after 30 months. No exudative lesion developed in laser-treated eyes

[Intravitreal triamcinolone acetonide in chronic refractory uveitis]

To evaluate the effect of intravitreal triamcinolone acetonide injection for management of chronic refractory uveitis in terms of inflammation, visual acuity and macular thickness. This interventional case series was conducted on uveitic eyes with no remission despite proper administration of periocular and/or systemic steroids. After systemic and rheumatologic evaluations and confirmation of non-infectious nature of uveitis, 18 eyes of 10 patients underwent intravitreal injection of 4 mg triamcinolone acetonide. Changes in intraocular inflammation, bestcorrected visual acuity [BCVA], intraocular pressure [IOP] and macular thickness on optical coherence tomography were assessed during six months of follow-up. Mean BCVA increased from a baseline value of 0.81 +/- 0.29 to 0.35 +/- 0.33 LogMAR one week and to 0.17 +/- 0.07 LogMAR one month after the injection, respectively [P<0.001]. It decreased thereafter to 0.46 +/- 0.3 LogMAR at the sixth month visit, but was still significantly greater than the baseline value [P<0.001]. Mean IOP reached its maximum level one month post-injection with an increase of 7.36 +/- 0.48 mmHg compared to the baseline value, however only two eyes had IOP>22 mmHg which were successfully controlled using topical IOP-lowering medication. Mean central macular thickness decreased from 339.8 +/- 24.1 microm to its minimum value [197.18 +/- 12.7 microm] one month after the injection [P<0.001] and then increased to 203.57 +/- 9.06 microm at sixth month visit, still less than the baseline value [P< 0.001]. Intravitreal injection of triamcinolone acetonide in chronic refractory uveitis improves visual acuity and decreases central macular thickness which is sustained for at least six months. The only noticeable complication, transient IOP elevation can be controlled with topical medications

[Frequency and severity of retinopathy of prematurity: singleton versus multiple-births]

To determine the frequency and severity of retinopathy of prematurity [ROP] among singleton and multiple-birth neonates referred to Farabi Eye Hospital, Tehran-Iran. We reviewed the records of 99 consecutive neonates from multiple-gestation pregnancies including 68 twins, 26 triplets and 5 quadruplets who were screened for ROP during 2002-2004. The frequency, severity and risk factors of ROP were determined. The results were compared with a group of singletons who did not differ from the multiple-birth group regarding birth weight, gestational age, oxygen therapy, respiratory distress syndrome, transfusion, sepsis, phototherapy and gender. ROP was present in 12.1% of multiple-birth neonates compared to 15.1% in singletons [P=0.53]. Threshold ROP was present in 6.1% of multiple-birth neonates and 7.1% of singletons [P=0.62]. ROP was detected in 60% of quadruplets vs 9.6% of twins and triplets with threshold disease in 40% of quadruplets compared to 4.2% in twins and triplets. Logistic regression analysis revealed no statistically significant differences in frequency and severity of ROP among subgroups of multiple-gestation pregnancies [P= 0.79]. The higher frequency of ROP among multiple-birth neonates is due to lower birth weight and gestational age but there is no significant difference between multiple-births and singletons in terms of frequency and stages of ROP. Screening for ROP in multiple pregnancy births may be conducted according to the same standard protocols as for singletons

[Prevalence and risk factors of retinopathy of prematurity in very low birth weight or low gestational age infants]

To determine the incidence of retinopathy of prematurity [ROP] and to evaluate the possible neonatal risk factors for ROP. This cross-sectional study included all premature infants born at hospitals affiliated to Tehran Medical University, Tehran-Iran who were referred within 4-6 weeks after delivery to Farabi Eye Hospital from 2004 to 2005. Inclusion criteria were birth weight [BW] < 1500 g or gestational age [GA] 32 wk who may be at high risk for ROP should also be screened

Vitrectomy for diffuse refractory diabetic macular edema associated with a taut premacular posterior hyaloid

To evaluate the anatomic and visual results and complications of vitrectomy in eyes with diffuse refractory diabetic macular edema associated with a taut posterior hyaloid. This prospective interventional case series was conducted in 25 eyes of 22 patients with diffuse clinically significant diabetic macular edema, macular thickness greater than 250 microns on optic coherence tomography [OCT] and thickened posterior hyaloid. Best-corrected visual acuity [BCVA] and macular thickness measured by OCT were evaluated preoperatively and 3 and 6 months postoperatively. Macular perfusion was evaluated by fluorescein angiography, preoperatively. Mean BCVA was 1.14 +/- 0.51 LogMAR, preoperatively and 0.89 +/- 0.53 LogMAR 6 months postoperatively [P=0.005]. Mean preoperative macular thickness was 506 +/- 121.9 micro m which decreased to 318 +/- 90.5 micro m, postoperatively [P=0.001]. Vitrectomy with removal of the posterior hyaloid membrane appears to be beneficial in some cases of diffuse persistent diabetic macular edema with a taut premacular posterior hyaloid unresponsive to laser therapy. Careful selection of eyes with favorable preoperative clinical characteristics may improve surgical outcomes

[Chorioretinitis sclopetaria: a case report]

To present a case of chorioretinitis sclopetaria with attached retina in spite of performing deep vitrectomy without retinopexy. A 10-year-old boy was referred due to air-gun injury to the left eye. Right eye had visual acuity of 20/16, MG, and normal slit lamp examination and fbndoscopy. In the left eye, visual acuity was count fingers at 50 cm, MG[+++], anterior segment examination revealed massive subconjunctival hemorrhage and chemosis. On B-Scan echography there was a suspicious retinal detachment. We performed standard pars plana deep vitrectomy with prophylactic band without endolaser retinopexy. The retina was attached until last follow up at 14 month. In spite of severe defects in the retina and choroid in chorioretinitis sclopetaria, retinal detachment does not usually occur due to spontaneous retinopexy and scar formation