Optical coherence tomographic findings in highly myopic eyes

Optical coherence tomography [OCT] had enhanced our understanding of changes in different ocular layers when axial myopia progresses and the globe is stretched. These findings consist of dehiscence of retinal layers known as retionoschisis, paravascularinner retinal cleavage, cysts and lamellar holes, peripapillary intrachoroidal cavitation, tractional internal limiting membrane detachment, macular holes [lamellar and full thickness], posterior retinal detachment, and choroidal neovascular membranes. In this review, recent observations regarding retinal changes in highly myopic eyes explored by OCT are described to highlight structural findings that cannot be diagnosed by simple ophthalmoscopy

Hyperhomocysteinemia and central retinal vein occlusion in Iranian population

To evaluate total plasma homocysteine level during the acute phase of central retinal vein occlusion [CRVO] compared with a matched healthy group in Iranian population, and determine whether hyperhomocysteinemia is also a risk factor for CRVO. A study group contains 54 patients presenting with CRVO in recent one month, acute phase of the decease, was compared for fasting total plasma homocysteine level with a matched control group of 51 patients evaluated in the same clinic for a non retinal disease diagnosis. The mean total plasma homocysteine level was 14.76 +/- 7.67 micro mol/l in cases, and 11.42 +/- 3.74 micro mol/l in control subjects. It shows a significant difference [p=0.005] in mean plasma homocysteine level between the cases and control group. Odds ratio of CRVO for individuals with hyperhomocysteinemia was 2.88 [95% Cl=1.08-7.71 and p=0.03]. The overall multivanable-adjusted odds of CRVO in participants with plasma homocysteine level above 15 micro mol/l was 4.71 [95% Cl=1.46-15.19 and p=0.009] Hyperhomocysteinemia was not statistically different in each age group [<60 years: 27%. 61-70 years: 33.3%, 71-80 years: 31.6%, >81 years: 33.3%], Chi-square test, p=0.98]. Elevated total plasma homocysteine level is an independent risk factor for CRVO in Iranian population. In addition to an evaluation of all conventional cardiovascular risk factors, measurement of total homocysteine for evidence of hyperhomocysteinemia may be important in the initial investigation and management of patients with CRVO

Comparison of the effect of adjuvant 5-fluorouracil, low molecular weight heparin and daunomycin in combination with triamcinolone during vitrectomy in advanced retinal detachment

To compare the success rate of adjunctive 5-fluorouracil [5-FU] and low molecular weight heparin [LMWH], and daunomycin in combination with triamcinolone during vitrectomy in eyes with retinal detachment [RD] and proliferative vitreoretinopathy [PVR]. In this prospective randomized clinical trial, 69 eyes from 69 patients with RD and PVR [grade B or C] randomized to 3 groups. Group 1: received 5-FU and LMWH [200 microgram/ml 5-FU and 5 IU/ml LMWH, Fragmin]; group 2: received daunomycin [0.5 mg] in 500 cc infusion fluid; and group 3: control group. In all patients, 0.1 cc intravitreal triamcinolone was used during vitrectomy. The patients visited on day 1, week 1, month 1, 3 and 6. Best corrected visual acuity [BCVA] and retinal status compared in the 3 groups. Complete data were available for 60 out of 69 patients. Thirty five patients [58.3%] were male and 25 patients [41.7%] were female. The patient age range was 19-84 years and the mean age was 49. The groups did not have significant difference in age, sex, duration of detachment, severity of PVR, preoperative visual acuity [V/A], lens status, type of tamponade and encircling band and buckle. Postoperative V/A and retina status also was the same in the 3 groups. Perioperative infusion of 5-FU, LMWH and daunomycin does not significantly increase the success rate of patients with RD and PVR comparing to control group. Although visual acuity improvement and retina reattachment rate in group 1 and 2 were better than control group, but statistical analysis failed to show significant difference between the 3 groups

Intravitreal bevacizumab versus combined bevacizumab and triamcinolone acetonide for neovascular age-related macular degeneration

To compare the short-term outcomes of intravitreal bevacizumab [IVB] with the combination of IVB and intravitreal triamcinolone acetonide [IVB/IVT] for treatment of neovascular age-related macular degeneration [AMD]. This randomized clinical trial was performed on 92 eyes of 90 patients with subfoveal and juxtafoveal choroidal neovascularization [CNV] secondary to AMD. The eyes were randomly assigned to receive IVB 1.25 mg alone [53 eyes] or in combination with IVT 2 mg [39 eyes]. Best-corrected visual acuity [BCVA] and fundus autofluorescence were assessed, and fluorescein angiography [FA] and optical coherence tomography [OCT] were performed at baseline and repeated 6 weeks after treatment. Mean age was 70.6 +/- 8.7 [range 50-89] years and 57.7% of the patients were male. BCVA improved from 1.03 +/- 0.40 to 0.93 +/- 0.38 logMAR [P=0.001] in the IVB group and from 1.08 +/- 0.33 to 0.91 +/- 0.38 logMAR [P=0.008] in the IVB/IVT group. There was a trend toward greater visual improvement with combined therapy [P=0.06]. BCVA improvement was greater in eyes with +1 versus those with +2 [P=0.049] and +3 [P < 0.001] fundus autofluorescence at baseline. Mean decrease in central macular thickness was 113 +/- 115 micro m [P < 0.001] in the IVB group versus 53.96 +/- 125 micro m [P=0.008] in the IVB/IVT group with no intergroup difference [P=0.38]. FA showed decreased leakage in 57.4%, increased leakage in 12.8% and no change in 29.8% of patients in the IVB group. Corresponding figures were 60.0%, 5.7% and 34.3% in the IVB/IVT group [P=0.556]. Addition of triamcinolone acetonide to bevacizumab for treatment of neovascular AMD does not seem to significantly increase its short-term efficacy. More severe fundus autofluorescence appears to be predictive of poorer response to treatment