ABSTRACT
AIM: To evaluate the role of a single intravitreal injection of tissue plasminogen activator ( TPA) alone for treatment of vitreomacular traction and the effect of combined intravitreal TPA and bevacizumab on retinal vascular diseases.? METHODS: In this prospective, interventional case series a total of 24 eyes from 24 patients were studied. There were 5 eyes with symptomatic vitreomacular traction syndrome ( VMT ) and 19 eyes with retinal vascular diseases including diabetic macular edema ( DME ) , diabetic vitreous hemorrhage ( VH ) , central retinal vein occlusion ( CRVO ) and neovascular age related macular degeneration ( AMD ) . Measurement of visual acuity, B-scan and OCT were performed at the baseline and 1mo after injections. Three eyes with VMT received a single intravitreal injection of 50 μg and two eyes received 100 μg TPA. And 19 eyes with retinal vascular diseases received combined intravitreal TPA ( 50μg) and bevacizumab (1. 25 mg).?RESULTS: The mean ages for retinal vascular diseases and VMT patients were 56. 8y and 60. 4y, respectively. Ten patients ( 41. 7％) were male and 14 patients ( 58. 3％) were female. And 22 eyes ( 91. 7％) were phakic and 2 eyes ( 8. 3％) were pseudophakic. The incidence of posterior vitreous detachment (PVD) was 0 (0 of 5) and 57. 8％ (11 of 19) for VMT and retinal vascular diseases, respectively (P= 0. 04). Improvement of best corrected visual acuity ( BCVA ) and decrement of central macular thickness ( CMT ) were significantly greater in PVD positive eyes compared with PVD negative eyes.?CONCLUSION: Intravitreal injection of TPA was not successful to induce complete PVD in VMT patients. Combined intravitreal injection of TPA and bevacizumab can induce PVD and improve BCVA and decrease central macular thickness in eyes with retinal vascular diseases.
ABSTRACT
Susac syndrome (SS) is a rare retinal‑cochlear‑cerebral disease with an unclear etiology. A 35‑year‑old man presented with sudden painless vision loss in the right eye and 2 months later in the left eye with hemiparesis, behavioral changes, and hearing loss. Ophthalmic examinations revealed multiple branch retinal artery occlusions (BRAOs) in both eyes. Brain magnetic resonance imaging showed inflammatory changes with multiple “punched‑out” lesions in the corpus callosum which confirmed the diagnosis of SS. Despite intravenous and oral corticosteroid therapy, the disease progressed with the development of new BRAOs, low vision in both eyes, and disability. Prompt diagnosis and early treatment may save the vision and even patient’s life.
ABSTRACT
Accreditation is one of the evaluating health care organization tools especially in hospitals and is also one of the priorities of Ministry of Health in Iran. The aim of this study was to examine the impact of accreditation on health service delivery in hospitals from perspective views of experts. This qualitative study was conducted by semi-structured interviews and opinions of 12 experts at Isfahan University of Medical Science in the field of hospital accreditation in 2012. After transcription of each interview, content analyses was used to minimize and structuring qualitative data. According to this study, 10 main theme and 72 sub- themes were identified. Main themes included: Necessity, implementations priorities and mechanisms of Accreditation effect, accreditation impact on service quality and organizational performance, patient satisfaction, commitment and job satisfaction of staff, reducing factors the impact of accreditation, confounder factors the effect of accreditation and the executive proposals in order to implement accreditation program in Iran. Accreditation could be properly implemented through setting Conditions, selecting the appropriate accreditation model, justify stakeholders about the necessity of accreditation, monitoring, establishment of appropriate information systems, information transparency and changing the general attitude of the organization. It would take positive effects to achieve hospital goals and improve the quality of services