Prevalence and risk factors of diabetes mellitus in a central district in Islamic Republic of Iran: a population-based study on adults aged 40-80 years

Previous studies on type 2 diabetes mellitus in the Islamic Republic of Iran were mainly performed in provinces with large populations. This study determined the prevalence and risk factors of diabetes mellitus in an adult population [40-80 years old] from Yazd district. Multistage, systematic cluster random sampling was used in a cross-sectional, population-based survey. Demographic, clinical and anthropometric data were collected, with diabetes defined as fasting blood sugar >/= 7 mmol/L or a positive medical history of diabetes. The age- and sex-standardized prevalence of diabetes in 2090 individuals participants was 24.5% [95% CI: 22.2-26.8%], including 10.5% new cases. For each year of ageing, the prevalence of diabetes increased significantly by 4% and this trend was more pronounced in females than males. Low education and hypertension were significantly associated with diabetes prevalence. The prevalence of diabetes mellitus in Yazd is greater than the average levels nationwide and those of nearby countries

[Randomized trial of intravitreal clindamycin and dexamethasone versus pyrimethamine, sulfadiazine, and prednisolone in treatment of ocular toxoplasmosis]

To compare the efficacy of intravitreal clindamycin and dexamethasone with classic treatment for ocular toxoplasmosis. In this prospective, randomized single-masked clinical trial a total of 68 patients with active ocular toxoplasmosis were assigned randomly to 2 treatment groups: 34 in the intravitreal clindamycin plus dexamethasone [IVCD] group and 34 in the classic treatment [CT] group. The IVCD group received 1 to 3 injection[s] of 1 mg intravitreal clindamycin and 400 microg dexamethasone, and the CT group received 6 weeks of treatment with pyrimethamine and sulfadiazine plus prednisolone. Antitoxoplasmosis antibodies [immunoglobulin [Ig] M and IgG] were measured using an enzyme-linked immunosorbent assay. The mean number of injections in the IVCD group was 1.6. Lesion size reduction was statistically significant after treatment in both IVCD and CT groups [P< 0.001 and P: 0.009, respectiveiy]. The difference in mean percentage of reduction at 6 weeks was not significant: 57 +/- 27.6% in the IVCD group versus 58.4 +/- 29.3% in the CT group. In comparison to baseline, VA increased by 0.44 +/- 0.24 and 0.29 +/- 0.19 logarithm of the minimum angle of resolution units in the IVCD and CT groups, respectively [P< 0.001]; however, the difference in VA improvement between the groups was not significant. The interaction effect of IgM and treatment group on lesion size reduction was significant [P= 0.002]; this indicated that IgM-positive cases responded better to CT and IgM-negative cases responded better to IVCD treatment. Vitreous inflammation reduction was comparable between the groups. Within 2 years, 4 eyes [2 in each group] had 1 episode of recurrence. Adverse drug reactions occurred in 2 patients in the CT group. No major injection-related complication was encountered in the IVCD group. Intravitreal injection of clindamycin and dexamethasone may be an acceptable alternative to classic treatment in ocular toxoplasmosis. It may offer more convenience, a safer systemic profile, greater availability, and fewer follow-up visits and hematologic evaluations

[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

[Causes of visual impairment among patients referred to rehabilitation clinics of Shahid Beheshti medical university]

To describe causes of low vision and blindness in patients referred for low vision aids to rehabilitation clinics at Shahid Beheshti Medical University during 2005. Visual acuity was classified to five groups based on best-corrected visual acuity [BCVA] in the better eye according to World Health Organization [WHO] criteria and by using standard Snellen chart which included mild, moderate, severe and profound low vision and blindness. The causes of blindness and low vision were determined using the 10[th] version of International Classification of Diseases [ICD-10] based on the main cause in both eyes. The study was performed on 432 patients including 275 [65%] male and 148 [35%] female subjects with mean age of 43.6 +/- 25.5 [range 3-92] years. Mild to moderate and severe low vision and blindness were present in 28.8%, 46.4% and 24.8% of cases, respectively. The main causes of visual impairment were diseases of the retina and choroid [74.5%], optic nerve and optic tract diseases [9.8%], vitreous and globe disorders [3.5%], congenital cataract [3.1%] and glaucoma [2.6%]. The pattern of distribution of the causes was almost similar in all age subgroups. Diseases of the retina and choroid are the main cause of visual impairment among patients referred to eye rehabilitation clinics

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

[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

[Confounding factors on the effect of Intravitreal triamcinolone for refractory diabetic macular edema]

To evaluate the influence of different confounding factors on the effect of intravitreal triamcinolone acetonide injection for refractory diabetic macular edema. In a prospective placebo-controlled randomized clinical trial, 88 eyes with refractory diabetic macular edema were randomly assigned into two groups including 45 in the treatment group [4 mg intravitreal triamcinolone acetonide] and 43 in the placebo group. Multivariate analysis was performed for three main outcomes, including visual acuity, central macular thickness, and the amount of hard exudates. Confounding factors that showed some effect on the main outcomes were used for building multivariate models. It was revealed that blood urea nitrogen, fasting blood sugar, serum cholesterol, initial visual acuity, presence of cystoid macular edema, amount of hard exudates, and size of foveal avascular zone had some influence on visual acuity outcome; previous macular photocoagulation, serum cholesterol, baseline central macular thickness, initial intraocular pressure, amount of hard exudates, and size of foveal avascular zone had some influence on visual acuity outcome; previous macular photocoagulation, serum cholesterol, baseline central macular thickness, initial intraocular pressure, amount of hard exudates, and size of foveal avascular zone had some influence on central macular thickness changes; and serum cholesterol, baseline central macular thickness, and amount of hard exudates had some influence on hard exudates in both groups. Size of foveal avascular zone, initial intraocular pressure, amount of hard exudates, and baseline central macular thickness also had an additive effect on the outcomes in the treatment group. Many confounding factors may influence the effect of intravitreal triamcinolone. These factors should be considered when adopting intravitreal triamcinolone. These factors should be considered when adopting intravitreal triamcinolone as a treatment strategy for refractory diabetic macular edema

[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