[Investigation of blood lead levels and its toxicity in workers of zinc melting factory of Dandi, Zanjan, Iran]

Environmental pollutions that affect human health are one of the important worries related to heavy metals production. Our objective of this study was to investigate the blood lead levels in workers of Zinc melting factory of Dandi Zanjan and to compare its level with healthy men who were living around the factory. This study was carried out on 40 workers as case group and 40 healthy non-worker male individuals who where living around the mentioned factory in Dandi region of Zanjan as control group. Blood lead concentrations was measured by graphite furnace atomic absorption spectrophotometer [GFAAS]. The data were analyzed using T-test and ANOVA. The mean of blood lead levels in case and control groups were 16.06 and 10.47- micro g/dL respectively [P = 0.0001]. There was also a significant difference between workers lead levels in different parts of the factory [P = 0.04]. Blood lead levels in factory workers were higher than in control group, although blood lead levels were in reference limit in workers on the basis of OSHA standards. Since the major way of lead pollution is respiratory tracts, therefore it is necessary to use appropriate air conditioner systems in such factories

[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

Results of post-trabeculectomy bleb revision using conjunctiva

To evaluate and compare the results of different surgical methods for post-trabeculectomy bleb revision at Labbafinejad Medical Center, Tehran-Iran, from 1999 to 2003. This study was conducted on all patients who underwent post-trabeculectomy bleb revision due to hypotony [intraocular pressure [IOP] less than 6 mmHg] or bleb leakage. Surgical methods were: conjunctival advancement, rotational conjunctival flap and free conjunctival graft. Bleb revision was performed in the cases of bleb leakage if the bleb hole was greater than 1 mm or leakage could not be controlled within 1 to 2 weeks of conservative treatment. Bleb revision was performed in eyes with hypotony in cases with cataract development or progression or hypotony maculopathy or iridocorneal adhesion. Surgical success was defined as IOP between 6-21 mmHg with a maximum of 2 topical antiglaucoma medications and discontinuation of leakage. Twenty-seven eyes of 27 patients [17 male, 10 female] with mean age of 37.8 +/- 15.2 years [9-37 years] were studied. Indication for surgery was bleb leakage in 22 cases [81.5%] and hypotonous maculopathy in 5 cases [18.5%]. Mean IOP was 4.4 +/- 1.04 mmHg preoperatively and 13.00 +/- 1.29 mmHg postoperatively. [P< 0.001] Mean visual acuity was 0.9 LogMAR [20/160] before surgery and reached 0.6 LogMAR [20/80] after bleb revision. [P<0.002] Mean cup/disc ratio was 0.7 preoperatively which remained unchanged postoperatively. Conjunctival advancement was performed in 18 cases [success rate = 72.2%], rotational conjunctival flap in 6 cases [success rate= 66.7%] and free conjunctival graft in 3 cases [success rate= 66.7%]. [P=0.73] Bleb revision was repeated in 2 cases due to continuous leakage. Mitomycin-C [MMC] and 5-fluorouracil had been used during primary trabeculectomy in 62% and 7.6% of cases, respectively. In 19.6% of cases surgery was done without using antimetabolites and usage of antimetabolites was unknown in 11%. The average time between primary trabeculectomy and bleb leakage or hypotonia was 17 months in cases with prior use of MMC and 52 months in the cases with no antimetabolite usage. [P<0.05] Post-trabeculectomy bleb revision using conjunctiva seems to be a successful method for control of leakage and prevention of complications of hypotony

[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