Causes of Visual Impairment among Patients Referred to a Visual Rehabilitation Clinic in Iran

PURPOSE: Epidemiologic evaluation and investigating the causes of visual impairment in any society is a matter of concern and has a direct effect on the country's health care planning. In this study we describe causes of low vision and blindness in Iranian patients referred to rehabilitation clinics for taking vision aids. METHODS: In this cross-sectional study, visual acuity was classified based on best-corrected visual acuity in the better eye according to the World Health Organization definition (blindness, visual acuity [VA] < 20 / 400; severe visual impairment, VA < 20 / 200-20 / 400; mild to moderate visual impairment, VA < 20 / 60-20 / 200). The causes of blindness and low vision were determined using the 10th version of International Classification of Diseases based on the main cause in both eyes. To describe data, we used mean +/- SD and frequency. RESULTS: The study included 432 patients, 65% male, with a mean age of 43.6 +/- 25.5 years (range, 3 to 92 years). Mild to moderate visual impairment, severe visual impairment and blindness were present in 122 (28.8%), 196 (46.4%) and 105 (24.8%) of the patients, respectively. The main causes of visual impairment were retinal and choroidal diseases (74.5%), optic nerve and optic tract diseases (9.8%), vitreous and globe disorders (5.3%), congenital cataract (3.1%), and glaucoma (2.6%). The distribution pattern of the causes was similar in all age subgroups. CONCLUSIONS: Diseases of the retina and choroid are the main cause of visual impairment among patients referred to an academic visual rehabilitation clinic in Iran.

Childhood pars planitis; clinical features and outcomes

To evaluate the demographic and clinical features of childhood pars planitis, and to determine the therapeutic and visual outcomes of the disease. Medical records of pediatric patients [less than 16 years of age at diagnosis] with pars planitis and at least 6 months of follow-up who were referred to Labbafinejad Medical Center, Tehran, Iran over a 22 year period were reviewed. Overall, 117 eyes of 61 patients including 51 [83.6%] male subjects were included. Mean age at the time of diagnosis was 7.8 +/- 3.2 [range, 3-16] years. Mean best corrected visual acuity [BCVA] was 0.88 +/- 0.76 logMAR at presentation which improved to 0.39 +/- 0.51 logMAR at final visit [P<0.001]. Endotheliitis was present in 23 [19.6%] eyes and was significantly more prevalent in subjects younger than 9 years [P=0.025]. Cataract formation [41.9%] and cystoid macular edema [19.7%] were the most prevalent complications. Univariate regression analysis showed that better baseline visual acuity [OR=0.38, 95%CI 0.21-0.70, P=0.002], age older than 5 years at disease onset [OR=0.36, 95%CI 0.14-0.9, P=0.029], absence of endotheliitis [OR=0.39, 95%CI 0.15-0.99, P-0.047] and female gender [OR=3.77, 95%CI 1.03-13.93, P=0.046] were significantly associated with final BCVA of 20/40 or better. Childhood pars planitis was much more common among male subjects. Endotheliitis may be a sign of inflammation spillover and is more prevalent in younger patients. Visual prognosis is favorable in most patients with appropriate treatment

Characteristics and surgical outcomes of rhegmatogenous retinal detachment following myopic LASIK

To describe the clinical features and surgical outcomes of rhegmatogenous retinal detachment [RRD] following myopic laser in situ keratomileusis [LASIK]. In a retrospective, non-comparative case series, 46 eyes that had undergone vitreoretinal surgery for management of RRD following myopic LASIK were identified. Data was reviewed with emphasis on characteristics of the RRD, employed surgical techniques, and anatomic and visual outcomes. Mean pre-LASIK myopia was -9.7 +/- 3.9 [range -4.00 to -18.00] diopters [D]. Mean interval between LASIK and development of RRD was 11.6 +/- 11.2 months. Posterior vitreous detachment was present in 44 eyes [95.6%]. The retinal breaks included flap tears in 36 [78.3%] eyes, giant tears in 8 [17.4%] eyes and atrophic holes in 2 [4.3%] eyes. In eyes with flap tears, the breaks were multiple, large or posterior to the equator in 24 [66.7%] eyes. Retinal breaks were related to lattice degeneration in 20 [43.5%] eyes of which, three had history of prophylactic barrier laser photocoagulation. Scleral buckling was performed as the initial procedure in 32 [69.6%] eyes and primary vitrectomy was undertaken in 14 [30.4%] eyes. The initial surgical procedure failed in 14 [30.4%] eyes due to proliferative vitreoretinopathy [PVR]. Retinal reattachment was finally achieved in 43 [93.4%] eyes. Postoperative visual acuity >/= 20/40 and >/= 20/200 was achieved in 16 [34.8%] and 25 [54.3%] eyes, respectively. Post-LASIK retinal detachment has a complex nature in eyes with moderate to high myopia. The retinal detachment is complex in terms of size, number and location of retinal breaks, is associated with a high rate of PVR and entails unfavorable visual outcomes

Protective role of antigens from peritoneal exudates of infected mice against toxoplasmosis

Toxoplasma gondii is an obligate intracellular parasite that infects all mammalian cells. Several antigens such as excreted/secreted antigens have been identified as a potential vaccine candidate. To determine how excreted/ secreted antigens from peritoneal exudates of infected mice [mESA] stimulate cell-mediated immune responses and induce protective immunity against toxoplasmosis in the murine model. The supernatants produced from the peritoneal fluids, were fractionated by precipitation in ammonium sulphate solution [30-80% saturated]. For induction of cell-mediated immune responses, delayed type hypersensitivity was measured, in injected footpad. Response to purified antigen was measured by lymphocyte proliferation assay. Nitric oxide was measured by Griess method. For immunization, Balb/c mice were immunized 2 times with mESA, mESA-40% and Toxoplasma Lysate Antigen [TLA]. The virulent RH strain of Toxoplasma gondii was used for challenging. The pattern of lymphocyte responsiveness was dependent on the antigen employed. In sensitized mice, those received mESA-40% displayed higher lymphocyte response than mice stimulated by mESA [p<0.05]. The highest amounts of nitric oxide were observed in macrophages, which received mESA-40% and mESA [p<0.05]. Mice immunized with mESA-40% survived longer than those immunized with mESA and other antigens [p<0.05]. As fraction 40% [mESA-40%] showed a good result in induction of cellmediated responses in the murine model, the purification and isolation of the mESA 40% is highly recommended for future study

Short-term results of two treatment regimens in ocular toxoplasmosis: trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine

To compare the efficacy of classic treatment for ocular toxoplasmosis [pyrimethamine, sulfadiazine and prednisolone] with a regimen consisting of trimethoprim/sulfamethoxazole [TMP/SMX] [co-trimoxazole] plus prednisolone. In a prospective randomized single-blind clinical trial, 59 patients with active ocular toxoplasmosis were randomly assigned to two treatment groups: 29 were treated with pyrimethamine/sulfadiazine and 30 patients received TMP/SMX. Treatment consisted of six weeks of treatment with antibiotics plus steroids. Anti-toxoplasmosis antibodies [IgM and IgG] were measured using ELISA. Outcome measures included changes in retinochoroidal lesion size after six weeks of treatment, visual acuity before and after intervention, adverse drug reactions during follow up and rate of recurrence. Active toxoplasmosis retinochoroiditis resolved in all patients over six weeks of treatment with no significant difference in mean reduction in retinochoroidal lesion size between the two treatment groups [61% reduction in the classic treatment group and 59% in the TMP/SMX group, P=0.75]. Similarly no significant difference was found in visual acuity after treatment between the two groups [mean visual acuity after treatment was 0.12 LogMAR [20/25] in classic treatment group and 0.09 LogMAR [20/25] in TMP/SMX group, P=0.56]. Adverse events were similar in both groups with one patient in each suffering from any significant drug side effects, The overall recurrence rate after 14 months of follow up was 6.7% with no significant difference between the treatment groups [P = 0.48]. Drug efficacy in terms of reduction in retinal lesion size and improvement in visual acuity was similar between a regimen of TMP/SMX and the classic treatment of ocular toxoplasmosis with pyrimetbamine and sulfadiazine. Therapy with TMP/SMX appears to be an acceptable alternative for the treatment of ocular toxoplasmosis

Outcomes of lensectomy in hereditary lens subluxation

To evaluate the results of pars plana lensectomy in patients with hereditary lens subluxation. Hospital records of patients with hereditary lens subluxation who had undergone pars plana lensectomy at Labbafinejad Medical Center, Tehran-Iran from 1996 to 2003 were reviewed. Patients with more than 6 months of follow up were included. Underlying disorders, best corrected visual acuity [BCVA] before and after surgery, intraocular pressure [IOP], postoperative refraction and complications were evaluated. Overall, records of 87 eyes of 49 patients including 27 male and 22 female subjects were reviewed. Mean follow up duration was 20 +/- 18 months. Underlying disorders leading to lens subluxation included Marfan syndrome [79.5%], Weill-Marchesani syndrome [82%], 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 [20/250] preoperatively, which improved to 0.26 LogMAR [20/30-20/40] postoperatively [P<0.001]. BCVA >/= 20/40 was achieved in 82.8% of cases after surgery. Angle-supported anterior chamber intraocular lens [ACIOL] was implanted in 85.1% of the eyes. Prophylactic band was applied in 63 eyes [72.4%]. Retinal detachment developed in four eyes [4.6%] and was successfully treated. Lensectomy/anterior vitrectomy with implantation of an angle-supported ACIOL in patients with hereditary lens subluxation improves vision significantly without considerable complications

Plasma level of vitamin C in women with pre-eclampsia in Ardabil, Iran

Pre-eclampsia, a vascular disorder of pregnancy, is a leading cause of maternal morbidity as well as perinatal morbidity and mortality. The cause of pre-eclampsia remains largely unknown. Accumulating evidences from clinical and epidemiological studies suggest that diffuse endothelial dysfunction, resulting from oxidative stress, plays an important role in the pathogenesis of pre-eclampsia. Independent effect of maternal biological markers, such as elevated triglyceride or low plasma vitamin C [ascorbic acid] concentrations are related to increased pre-eclampsia risk. The aim of this study was to determine plasma concentrations of vitamin C in women with pre-eclampsia. This cross-sectional, case controlled study comprises 40 pre-eclamptic and 80 normo-tensive pregnant women of singleton gestations in third trimester, in Allavi Hospital, Ardabil, Iran. Blood samples [5ml] were collected aseptically in heparin tube, and the plasma concentration of vitamin C was determined by spectrophotometric method. SPSS software package was used for analyzing the data. Plasma vitamin C level was found to be significantly lower [p<0.001] in the pre-eclampsia group than this level in the control group. Vitamin C levels in the pre-eclampsia group were found to be influenced by their maternal age [p<0.01], and was positively related to the gestational age [p<0.01]. Knowledge from this study may contribute to the development and evaluation of behavioral and medical interventions aimed at reducing the occurrence of pre-eclampsia

Antifertility effect of Iranian neem seed alcoholic extract on epididymal sperm of mice

About 90% of the world's contraceptive users are women. This gender-based usage has occurred due to the emphasis of family planning programs and contraception research. Condom, vasectomy and withdrawal are the only male contraception devices available with less assurance for men. For new male contraceptive to have an impact, they must be acceptable to both men and women, as well as effective. A hormonal method will likely come to the market within the next few years. It is necessary to use biologically active botanical substances or fertility-regulating agents of plant origin which are ecofriendly. The epididymis is a site which can be exploited for male contraception without undue side effects. It was therefore of interest to investigate the effect of biologically active botanical ecofriendly plants such as Azadirchta Indica [neem] seed alcoholic extract as an efficient and competent male contraceptive on male mouse epididymis. In this experimental case control study sixty adult healthy mice divided into two groups of 40 as the control and 20 as the treated group. The treated group was administered by Iranian Botanical Azadirachta Indica seed alcoholic extract, cultivated at Dashteh Moghan [Ardabil province]. The seeds were extracted with ethanol then administered first 50 mg/kg body weight /day then 100 mg/kg body weight/day orally for 15 days, following WHO guide lines [MB-50]. The target organ, epididymis parameters viz. sperm motility, sperm count fertility rate, Scanning Electron Microscopic [SEM] morphology of spermatozoa and ATPase activity of epididymis of the two groups were compared. The 50 mg/kg body weight [BW] day showed no significant change in epididymis sperm motility, as compare to the control. Therefore the dose was changed to 100 mg/kg BW/day for 15 days. The body and organ weights [epididymis] of the treated animals were not significantly changed as compare to control group [p>0.05]. The treatment brought about a significant reduction in fertility rate when normal cycling female mice were mated with treated males [p<0.001]. Decline in ATPase activity in caput and cauda epididymis was observed [p<0.001]. SEM photographs showed spermatozoa with abnormal head and bent mid-piece region. Decrease in ATPase activity could be attributed to androgen dependent parameters. However, the fertility rate was also significantly reduced which can be due to the decrease in cauda epididymal sperm motility and their morphological abnormalities. Since the effect on epididymal sperm motility and morphology was manifested in short period of 15 days, it is evident that the extract has potential as an antifertility agent. As this extract do not cause change in the body and organ weight, it is likely that no effect occurred on electrolyte balance