[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

[Incidence, severity and risk factors for retinopathy of prematurity in premature infants with late retinal examination]

To determine the incidence, severity and risk factors for retinopathy of prematurity [ROP] in premature infants with late retinal examination at Farabi Hospital from 2001 to 2006. In a cross-sectional study, hospital records of premature infants who were examined later than 9 weeks after birth were reviewed for possible risk factors of ROP including gender, singleton or multiple gestations, gestational age [GA], birth weight [BW], oxygen therapy, blood transfusion, phototherapy, and respiratory distress syndrome [RDS], as well as the age at initial examination. From 693 infants referred for ROP screening, 191 [27.6%] had late retinal examination at mean age of 144.8 +/- 158.4 [range 64-1460] days. Of these 191 infants, 75 [39.3%] had different stages of ROP, 58 [30.4%] had stage 4 or 5 disease and 27 [14.1%] had stage 5 ROP in both eyes which were untreatable. GA and BW were associated with development of ROP [P<0.001]. The high prevalence of premature infants with late retinal examination and high incidence of severe ROP necessitates prompt intervention to optimize referral and early screening of premature infants

[Intravitreal triamcinolone for treatment of refractory diabetic macular edema]

To determine if intravitreal injection of triamcinolone acetonide is safe and effective in the treatment of diabetic macular edema unresponsive to prior laser photocoagulation. Fifty-four eyes of 38 patients with clinically significant macular edema which had received at least two sessions of laser photocoagulation according to Early Treatment Diabetic Retinopathy Study guidelines were enrolled in this study. At least four months after laser therapy; eyes with residual central macular thickness [CMT] greater than 250 microm on optical coherence tomography [OCT] and visual loss from baseline were offered intravitreal injection of 4 mg triamcinolone acetonide. Visual and anatomic responses as well as complications related to the injection procedure and corticosteroid medication were observed. Mean baseline best corrected visual acuity [BCVA] and CMT were 0.77 +/- 0.5 LogMAR and 443 +/- 138 microm, respectively. All patients completed one month of follow up and 39 of 54 eyes [72.2%] completed 6 months of follow up. Mean BCVA was 0.64 +/- 0.45, 0.56 +/- 0.48, and 0.79 +/- 0.55 LogMAR at months 1, 3, and 6, respectively. Central macular thickness measured by OCT decreased by 39% and 23.5%, at the third and sixth month visits, respectively. Intraocular pressure exceeded 21 mmHg in 36.3% of the eyes. Cataract progression was noted in 12.8% of phakic eyes. Intravitreal triamcinolone seems a promising therapeutic method for diabetic macular edema refractory to conventional laser photocoagulation without any significant complication, however the effect seems to be temporary. Further studies are warranted to assess the long-term efficacy and safety and also the need for retreatment

[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

[Characteristics of patients with central retinal artery occlusion in an Iranian tertiary eye center]

To evaluate the etiologic and epidemiologic findings in central retinal artery occlusion [CRAO] patients in a tertiary eye center in Tehran, Iran. All patients with CRAO refered to the emergency department of Farabi Hospital during 200 1-2002 were enrolled in the study. All patients received routine treatment and were followed for 3 months. Cardiology consult was done for all patients. From 36 patients, 6 patients had cilioretinal artery sparing. Age of patients ranged from 18 to 80 years [56.3 +/- 15.7]. Interval from onset of symptoms to admission was between 4 48 [20 +/- 8] hours. Prevalence of NVI, hypertension, and diabetes mellitus was 6.6%, 36.7%, and 16.7%, respectively. The lower mean age in our patients compared to other studies is probably due to longer duration of life in western countries or decreasing atherosclerosis age in our country. The low prevalence of hypertension and diabetes mellitus in our patients require further evaluation in great scale studies. The low prevalence of NVI in our study may be due to earlier presentation of our patients or special characteristics of this disease in our country

Incidence and risk factors of Retinopathy of prematurity

To determine the incidence of retinopathy of prematurity [ROP] and to evaluate the possible neonatal risk factors for ROP among premature infants referred to Farabi Eye Hospital during 2000-2002.Newborn infants with gestational age [GA] 37 wk or birth weight [BW] 2500 g were included. The first eye examination was performed 4-9 weeks after birth. Data on possible risk factors include low birth weight, low gestational age, sepsis, supplemental oxygen therapy, blood transfusion, phototherapy, multiple pregnancy, and respiratory distress syndrome [RDS] were compared between the two groups of newborns with and without ROP. Univariate and multivariate analysis was performed.One hundred eighty five neonates were included in this study [110 male, 75 female]. Mean GA +/- SD was 31.64 +/- 2.67 wk and mean BW +/- SD was 1620.68 +/- 467.6 g. The incidence of ROP was 12.4% [95%0: 7.6%-17.2%] including 8.6% in threshold and 3.8% in prethreshold stages. ROP was present in 18.6% of neonates with GA < 32 wk and 29% of neonates with GA < 28 weeks. All ROP cases had GA 5 wk. Mean GA +/- SD was 29.39 +/- 2.16 wk in the ROP group and 3196 +/- 2.58 wk in the non-ROP group. [P< 0.001] Mean BW +/- SD was 1283.48 +/- 342.84 g in the ROP group and 1668.55 +/- 464.04 g in the non-ROP group. [P< 0.001] ROP was pesent in 20.5% of neonates with BW S 1500 g. All ROP cases had BW 2000 g. There was a significant association between blood transfusion and incidence of ROP [odds ratio= 3.75, P= 0.004], RDS [OR= 3.14, 0.041], and phothotherapy [OR= 2.86, P= 0.044] based on univariate analysis. There was no significant association between oxygen therapy and incidence of ROP. Based on multivariate logistic regression analysis, low GA was the only significant factor associated with high incidence of ROP. We suggest GA < 33 wk and BW < 2000 g as the best criteria for screening of high neonates for developing ROP. These criteria deserve further investigation