[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

[Medication error following intraocular surgery at a tertiary eye care center]

To evaluate the incidence of medication error in patients who underwent intraocular surgery based on different methods of drug instruction [hand-written versus orally explained] at Labbafinejad Medical Center. During a 6-month period, we evaluated 204 postoperative patients who underwent cataract or glaucoma surgery. Patients were randomly assigned to two groups; in group I, patients and their attendants received oral and written instruction in addition to the prescription, while the patients and their attendants in group II only received oral instruction besides the prescription. One to 3 days after the operation, the overall incidence of medication errors was determined and compared between the groups using Fisher's exact test. Overall 204 patients including 114 [55.9%] male and 90 [44.1%] female subjects were studied. Mean age of the patients and their attendants was 53.5+22.1 [range 1-90] years and 39.1+12.2 [range 19-79] years, respectively. Actual medication errors occurred in 7 patients including 3 [3%] in the group with written instruction and 4 [3.9%] in the group with oral instruction [P=0.511]. Dispensing errors were the cause in 5 [71.4%] patients including 3 in group I and 2 in group II [P=0.491] but the 2 [28.6%] other cases were due to misconsumption [all in group II]. Overall, 3 medication errors were detected and corrected [intercepted errors] by the patients or their attendants [all in group I] thus; nonintercepted errors were 4 [all in group II]. Cases of actual medication errors were female in 6 [85.7%] and illiterates in 4 [57.1%]. It seems that using a written instruction in addition to the prescription may reduce the incidence of medication errors following ocular surgery

[Visual outcomes of 4 therapeutic approaches for central retinal vein occlusion]

To compare the visual outcomes of four different therapeutic modalities for central retinal vein occlusion [CRVO] with each other and with the natural course of the disease. This study was conducted on 63 eyes of 63 patients including 13 eyes in the radial optic neurotomy [RON] group, 10 eyes in the combined RON and intraocular triamcinolone injection [RON/IOT] group, 12 eyes in the combined internal limiting membrane peeling, RON and IOT [ILMP/RON/IOT] group, 14 eyes in the intravitreal triamcinolone injection [IVT] group and 14 untreated control eyes. All patients were followed for six months. Final best-corrected visual acuity [BCVA] was better in the IVT group as compared to the RON [P=0.037], RON/IOT [P=0.401], ILMP/RON/IOT [P=0.023] and control [P=0.025] groups. However, after adjusting final BCVA for baseline BCVA, only the RON/IOT group showed significant visual improvement after 1 [P= 0.025], 3 [P= 0.023] and 6 [P= 0.054] months as compared to controls. Among the four different approaches evaluated in this study, RON/IOT may entail better visual outcomes in the management of CRVO within six months

[Combined sutureless 25-gauge vitrectomy, phacoemulsification, and posterior chamber intraocular lens implantation for management of uveitic cataracts associated with posterior segment disease]

To report the visual outcomes and complication of one-stage surgery for management of uveitic cataracts associated with posterior segment disease. In this retrospective interventional case series, 19 eyes of 19 patients with posterior segment involvement due to chronic uveitis underwent sutureless scleral tunnel incision phacoemulsification combined with total vitrectomy using 25-gauge instruments and posterior chamber intraocular lens [PCIOL] implantation. Membrane peeling and endolaser photocoagulation were performed when indicated. Outcome measures were visual acuity, inflammatory activity, macular edema and surgical complications. After a minimum 12-month follow-up, visual acuity was >/=20/100 in 12 eyes [63.2%] and >/=20/40 in 6 eyes [31.6%]. One grade of decrease in postoperative inflammatory activity was observed in 8 eyes [42.1%]. Cystoid macular edema was present in 16 eyes preoperatively and in 12 eyes postoperatively. Early postoperative complications included transient corneal edema in 10 eyes [50.3%], posterior synechia in 9 eyes [47.3%] and fibrin reaction in 3 eyes [15.8%]. Glaucoma was the most common late postoperative complication [3 eyes, 18.8%]. Nine eyes [47.4%] needed YAG laser capsulotomy during the first year. Combined sutureless 25-gauge vitrectomy, phacoemulsification, and PCIOL implantation may be a well tolerated procedure with an acceptable complication rate for visual restoration in selected uveitic eyes with significant cataract and coexisting posterior segment disease