[Combined transpupillary thermotherapy with subtenon triamcinolone injection in treatment of choroidal neovascularization secondary to exudative age related macular degeneration]

In spite of several treatment methods which are being used to treat exudative age-related macular degeneration [ARMD] like laser therapy, Intravitreal steroids injections or anti-vascular endothelial growth factors [VEGF], no method has been yet presented as the best treatment way. This study aimed to assess the effectiveness of combined transpupillary thermotherapy [TTT] with subtenon triamcinolone acetonide [TA] injection in treatment of choroidal neovascularization [CNV] in patients with ARMD. In this clinical trial, 63 eyes of 57 patients with CNV secondary to exudative age-related macular degeneration [ARMD] were studied. All CNVs [including 20 predominantly classic and 43 predominantly occult lesions] were treated with diode laser [810nm]. In 20 eyes with predominantly classic CNVs, 20 mg and 40 mg subtenon triamcinolone was injected in 12 and 8 eyes respectively. The patients were followed for a mean of 9.1 months [ranging from 5.5 to 16 months]. The average number of treatment sessions was 1.25. In 43 eyes with occult CNV, 20 mg and 40 mg subtenon triamcinolone was injected in 31 eyes and in 12 eyes respectively. Mean follow up time was 12 months [4.5 to 23 months]. Mean treatment times was 1.17. A variable spot size of 0.8, 1.2, 2 and 3 mm was used depending on the size of CNV; and treatment was given in one area for 1 minute. Thermotherapy was adminstered through a contact lens at a power range between 120-560 mw. At the end of treatment, each patient randomly received 20 mg or 40 mg subtenon triamcinolone acetonide injection in superotemporal quadrant. Outcome was assessed with clinical and angiographic examination collected data were analyzed by one-sample and paired - sample T test, using SPSS software. At the end of the study in first group, visual acuity remained stable [0 to +/- one line] in 14 out of 20 [70%] of eyes, improved [> one line] in 2 of 20 [10%] eyes and showed a decline [> one line worsening] in 4/20 [20%] eyes. In second group thirty one eyes [72.1%] had stable vision [ +/- 1 line], 4 eyes [9.32%] had better vision more than 1 line and 8 eyes [18.6%] had more than 1 line decrease in vision. All CNVs were closed in last follow up. No statistically significant difference was found between two groups in clinical and functional with 20 mg and 40 mg injection of subtenon TA. Combined TTT and subtenon injection of TA in eyes with exudative ARMD can be an effective method to stabilize visual acuity of these patients

[Correlation between Intracranial and Intraocular Pressures]

To evaluated the correlation between intracranial pressure [ICP] and intraocular pressure [IOP]. This interventional case series included 90 patients undergoing lumbar puncture [LP] for neurologist evaluation. IOP was measured before and 1 hour after the LP by using Goldmann tonometer. Patients were compared into two groups: patients with normal ICP [<20 cmH2O] and patients with high ICP [>/=20 cmH2O]. Patients included 29 male and 61 female subjects with mean age of 32.9 +/- 11.4 [range 13-62] years. Thirty-three patients had normal ICP and 57 patients had high ICP. There was a significant correlation between ICP and IOP such that 71.9% of the high ICP group had high IOP [>/=21 mmHg] and 28.1% of them had normal IOP [P<0.001]. Significant decrease in IOP occurred after LP in the high ICP group [P< 0.001]. It seems that there is a significant correlation between IOP and ICP

[Correlation between nerve fiber layer thickness on OCT and visual field in patients with optic atrophy]

To evaluate the correlation between retinal nerve fiber layer [NFL] thickness and visual field parameters in patients with optic atrophy. This study was performed on 35 eyes of 28 patients with optic atrophy. NFL thickness was measured by optic coherence tomography [OCT] and visual field analysis was performed by Humphrey perimetry. The correlation between NFL thickness and visual field parameters was evaluated. Mean NFL thickness was 44.9 +/- 27.5 micro which was significantly correlated with mean deviation of perimetry [r=0.493, P=0.003]; however, no significant difference was found between quadrant NFL thickness and corresponding visual field pattern standard deviation. No significant correlation was found between visual acuity and NLF thickness. Similar to visual field, OCT can be used as an objective diagnostic tool in optic atrophy suspected patients

[Outcomes of heavy silicone oil tamponade in complicated retinal detachment surgery]

To evaluate the outcomes of internal tamponade using heavy silicone oil in complicated retinal detachment [RD] surgery. In this interventional case series, patients with complicated RD involving the inferior retina were enrolled. Inclusion criteria included RD secondary to proliferative vitreoretinopathy [PVR CP6 and/or CA6] involving the inferior retina, inferior or posterior tears, giant tears, penetrating trauma or RD combined with choroidal detachment. Heavy silicone [Oxan HD, Bausch and Lomb, USA] was injected at the end of surgery after peeling of retinal membranes or retinotomy. Follow-up examinations were scheduled one day, one week, one month and four months after surgery. Additional visits were made depending on the condition of the eye. Seventeen eyes of 17 patients with mean age of 45.4 +/- 12.2 [range 19-71] years underwent vitrectomy and heavy silicone oil tamponade. Mean follow-up was 11.4 +/- 3.5 [range 4-16] months. There was total RD in 10 cases, subtotal RD involving the inferior retina in 6 patients and RD associated with choroidal detachment in one. Best-corrected visual acuity [BCVA] before surgery was LP or HM in 13 eyes and counting fingers at 0.5 to 3 m in 4 eyes. During the follow-up period, the retina remained attached in 12 cases [70/5%] but 5 eyes needed further vitrectomy for reattachment. BCVA improved from 1.95 +/- 0.09 LogMAR preoperatively to 1.5 +/- 0.35 four months after the operation [P=0.045]. After 4 months' follow-up BCVA was HM in 4 eyes and 0.5 m to 20/200 in 13 eyes. Transient IOP rise occurred in one eye and silicone oil emulsification was seen in another eye. Heavy silicone oil tamponade had favorable results in terms of anatomical attachment of the retina and visual acuity

[Outcomes and prognosis of treatment for retinoblastoma with primary chemotherapy and focal treatment]

To determine globe and patient survival in children with retinoblastoma at a major referral center in Iran. Hospital records of 156 eyes of 105 patients with retinoblastoma referred to the Ocular Oncology Center at Rasoul Akram Hospital, Tehran, Iran from 2001 to 2007 were reviewed. Demographic data, family history, presenting symptoms, duration of symptoms, ocular findings and treatment modalities were evaluated. Main outcome measures included patient survival with the event of death, and globe survival with the event of enucleation. Mean age at the time of diagnosis was 28.5 +/- 23.0 [range 3-120] months. Mean follow-up was 30.9 +/- 29.0 [range 3-72] months. Male to female ratio was 47/58. Five patients had positive family history. Involvement was unilateral in 52% and bilateral in 48% of patients. Enucleation was performed as primary treatment in 76 eyes [48.7%] and as secondary treatment for recurrence in 11 eyes [7.1%]. Sixty nine eyes [44.2%] were salvaged by different globe preserving modalities. Kaplan-Meier 5-year survival estimate for globe preservation according to the International Classification of Retinoblastoma [ICRB] was 100% for group A, 93.5% for group B, 86.7% for group C, 57.1% for group D and 0% for group E. Kaplan-Meier estimates for 5-year patient survival was 100% for ICRB groups A and B, 92.3% for group C, 73.3% for group D and 79.9% for group E. Five year patient survival rate was better in ICRB groups A to D than in group E [P=0.004]. Advances in treatment, early diagnosis and prompt referral have improved the prognosis of patients with retinoblastoma in terms of globe and patient survival

[Pupil dilation with intracameral lidocaine during phacoemulsification]

To evaluate pupil dilation with intracameral injection of preservative-free lidocaine 1% during phacoemulsification. This interventional case series included 31 consecutive senile cataract patients scheduled for phacoemulsification and intraocular lens [IOL] implantation. Pupil dilation was achieved using intracameral preservative-free lidocaine 1% without any preoperative or intraoperative mydriatics. Pupil diameter was measured by calipers immediately before and 90 seconds after intracameral injection of lidocaine. Patients included 16 male and 15 female subjects with mean age of 67.3 +/- 9.9 years. Four patients were diabetic and four cases had pseudoexfoliation. Pupil diameter increased from 2.63 +/- 0.3 mm preoperatively to 7.03 +/- 0.61 mm 90 seconds after intracameral injection of lidocaine with a mean increase of 4.39 +/- 0.53 mm [range 3.4-5.2, P<0.001]. Mean post-injection mydriasis was significantly greater in patients without pseudoexfoliation [7.1 mm vs 6.00 mm, independent t test and Mann-Whitney test, P<0.01]. There was no significant difference between diabetic and nondiabetic patients regarding of pre- and post-injection diameter of the pupil. Intracameral preservative-free lidocaine 1% provides rapid and effective mydriasis and can be a safe alternative to other topical and intracameral mydriatics used in phacoemulsification

[Central corneal thickness, endothelial characteristics and intraocular pressure in congenital cataract extracted eyes]

To investigate central corneal thickness [CCT], endothelial cell characteristics and intraocular pressure [IOP] in congenital cataract extracted eyes and to compare the results with eyes of normal age and sex matched controls. CCT and IOP measurements and specular microscopy were performed in 31 eyes of 17 cases of extracted congenital cataracts and 40 eyes of 20 age and sex matched subjects as control group. Mean of three pachymetry measurements of the central cornea was taken as CCT. IOP was measured using an applanation tonometer. Mean CCT was 632 +/- 45 microm in cataract extracted eyes vs 546 +/- 33 microm in the control eyes [P<0.001, independent t test and Mann Whitney test]. There was no significant difference in cell count, coefficient of variation, and mean cell area of the corneal endothelial cells between the two groups. Mean IOP was 22.1 +/- 3.9 mmHg in the cataract extracted eyes and 14.0 +/- 1.6 mmHg in the control group [P<0.001, independent t test]. Although the cornea was clinically clear and there was no significant difference in endothelial characteristics of congenital cataract extracted eyes compared to normal controls, central corneal thickness in operated eyes was significantly greater than that of controls. To differentiate actual glaucoma from artifactual IOP increase, CCT measurement should strongly be considered in these patients