ABSTRACT
To evaluate the success rate of Nd:YAG laser membranotomy in patients with diabetic premacular hemorrhage. This interventional case series included 24 eyes of 22 patients referred to retina clinic of Farabi Eye Hospital, Tehran, Iran during 2000-2007 with chief complaint of sudden loss of vision and clinical diagnosis of premacular hemorrhage due to proliferative diabetic retinopathy. All patients underwent complete ocular examination and color fundus photography. Nd:YAG laser membranotomy was performed in patients with >3 DD hemorrhage. Main outcome measures were success rate of membranotomy, improvement of visual acuity and the complications. Twenty-four eyes of 22 patients [68.2% female and 31.8% male] with diabetic premacular hemorrhage were enrolled. Mean age of patients was 56 +/- 6.5 years. Nd:YAG laser membranotomy was successful in 71% of patients resulting in release of trapped blood into the vitreous cavity which absorbed during 14.3 +/- 5.03 [range 8 to 27] days. Range of preoperative visual acuity was from hand motion to count finger at 4 m which improved to a range of 20/100 to 20/25 postoperatively. Patients complained of some visual disorders such as blurred vision and floater over 23-86 days [mean 43 days], postoperatively. Macular photocoagulation was performed in 11 eyes with macular edema before panretinal photocoagulation. Mean follow-up period was 34.7 +/- 18.3 [range 10-71] months. Nd:YAG laser membranotomy in diabetic premacular hemorrhage is a simple and inexpensive outpatient procedure which results in rapid visual recovery and is relatively safe. Further controlled clinical trials are recommended
ABSTRACT
To determine the incidence, severity and risk factors for retinopathy of prematurity [ROP] in premature infants with late retinal examination at Farabi Hospital from 2001 to 2006. In a cross-sectional study, hospital records of premature infants who were examined later than 9 weeks after birth were reviewed for possible risk factors of ROP including gender, singleton or multiple gestations, gestational age [GA], birth weight [BW], oxygen therapy, blood transfusion, phototherapy, and respiratory distress syndrome [RDS], as well as the age at initial examination. From 693 infants referred for ROP screening, 191 [27.6%] had late retinal examination at mean age of 144.8 +/- 158.4 [range 64-1460] days. Of these 191 infants, 75 [39.3%] had different stages of ROP, 58 [30.4%] had stage 4 or 5 disease and 27 [14.1%] had stage 5 ROP in both eyes which were untreatable. GA and BW were associated with development of ROP [P<0.001]. The high prevalence of premature infants with late retinal examination and high incidence of severe ROP necessitates prompt intervention to optimize referral and early screening of premature infants
ABSTRACT
To develop strategic planning for ophthalmology education in Iran from 2008 to 2010. A qualitative investigation using focus group discussion was conducted during March, 2008 at the Ophthalmic Research Center of Shahid Beheshti University. Six to ten academic members of the ophthalmology department and other stakeholders participated in this study. Strengths, weaknesses, opportunities and threats related to ophthalmology education in Iran were analyzed. Strategic goals for education, research, and health service providing domains were evaluated. Educational goals were defined as the training of human resources in accordance with community needs at the level of general practitioner, specialist, and fellowships in ophthalmology. Research goals of the program were defined as scientific inter-departmental and international communications, in order to promote the level of education, research and treatment in the country. Also, in the field of health services and according to community needs, providing services by means of advanced and costeffective methods were defined as strategic objectives. Results of this study underscore the necessity for supporting of health decision makers in Iran
ABSTRACT
To determine if intravitreal injection of triamcinolone acetonide is safe and effective in the treatment of diabetic macular edema unresponsive to prior laser photocoagulation. Fifty-four eyes of 38 patients with clinically significant macular edema which had received at least two sessions of laser photocoagulation according to Early Treatment Diabetic Retinopathy Study guidelines were enrolled in this study. At least four months after laser therapy; eyes with residual central macular thickness [CMT] greater than 250 microm on optical coherence tomography [OCT] and visual loss from baseline were offered intravitreal injection of 4 mg triamcinolone acetonide. Visual and anatomic responses as well as complications related to the injection procedure and corticosteroid medication were observed. Mean baseline best corrected visual acuity [BCVA] and CMT were 0.77 +/- 0.5 LogMAR and 443 +/- 138 microm, respectively. All patients completed one month of follow up and 39 of 54 eyes [72.2%] completed 6 months of follow up. Mean BCVA was 0.64 +/- 0.45, 0.56 +/- 0.48, and 0.79 +/- 0.55 LogMAR at months 1, 3, and 6, respectively. Central macular thickness measured by OCT decreased by 39% and 23.5%, at the third and sixth month visits, respectively. Intraocular pressure exceeded 21 mmHg in 36.3% of the eyes. Cataract progression was noted in 12.8% of phakic eyes. Intravitreal triamcinolone seems a promising therapeutic method for diabetic macular edema refractory to conventional laser photocoagulation without any significant complication, however the effect seems to be temporary. Further studies are warranted to assess the long-term efficacy and safety and also the need for retreatment
ABSTRACT
To determine the frequency and severity of retinopathy of prematurity [ROP] among singleton and multiple-birth neonates referred to Farabi Eye Hospital, Tehran-Iran. We reviewed the records of 99 consecutive neonates from multiple-gestation pregnancies including 68 twins, 26 triplets and 5 quadruplets who were screened for ROP during 2002-2004. The frequency, severity and risk factors of ROP were determined. The results were compared with a group of singletons who did not differ from the multiple-birth group regarding birth weight, gestational age, oxygen therapy, respiratory distress syndrome, transfusion, sepsis, phototherapy and gender. ROP was present in 12.1% of multiple-birth neonates compared to 15.1% in singletons [P=0.53]. Threshold ROP was present in 6.1% of multiple-birth neonates and 7.1% of singletons [P=0.62]. ROP was detected in 60% of quadruplets vs 9.6% of twins and triplets with threshold disease in 40% of quadruplets compared to 4.2% in twins and triplets. Logistic regression analysis revealed no statistically significant differences in frequency and severity of ROP among subgroups of multiple-gestation pregnancies [P= 0.79]. The higher frequency of ROP among multiple-birth neonates is due to lower birth weight and gestational age but there is no significant difference between multiple-births and singletons in terms of frequency and stages of ROP. Screening for ROP in multiple pregnancy births may be conducted according to the same standard protocols as for singletons
ABSTRACT
To determine the incidence of retinopathy of prematurity [ROP] and to evaluate the possible neonatal risk factors for ROP. This cross-sectional study included all premature infants born at hospitals affiliated to Tehran Medical University, Tehran-Iran who were referred within 4-6 weeks after delivery to Farabi Eye Hospital from 2004 to 2005. Inclusion criteria were birth weight [BW] < 1500 g or gestational age [GA] 32 wk who may be at high risk for ROP should also be screened
ABSTRACT
To evaluate the analgesic effect of topical sodium diclofenac 0.1% during pan-retinal photocoagulation [PRP] in patients with proliferative diabetic retinopathy [PDR]. Two-hundred informed patients [102 male, 98 female] with PDR were enrolled in this randomized controlled double-masked clinical trial. The treatment group received sodium diclofenac 0.1% eye drops and controls received artificial tear 30, 60 or 90 minutes before laser therapy in a masked and random fashion. Pain level was evaluated immediately after PRP using the Scott's visual analogue scale. Mean patient age was 53.6 +/- 14.2 [range 20-82] years. Average pain level was 46% in the treatment group vs 77% in controls [P<0.0001, t-test]. Average pain level was 42% in female vs 46% in male subjects in the treatment group [P=0.014, t-test]. There was no correlation in either group between pain level and age, number of laser spots, time interval from application of the drops to laser treatment [30, 60 or 90 minutes] and using daily aspirin. Using topical sodium diclofenac 0.1% before PRP in patients with PDR is a useful method for pain reduction
ABSTRACT
To evaluate the anatomic and visual results and complications of vitrectomy in eyes with diffuse refractory diabetic macular edema associated with a taut posterior hyaloid. This prospective interventional case series was conducted in 25 eyes of 22 patients with diffuse clinically significant diabetic macular edema, macular thickness greater than 250 microns on optic coherence tomography [OCT] and thickened posterior hyaloid. Best-corrected visual acuity [BCVA] and macular thickness measured by OCT were evaluated preoperatively and 3 and 6 months postoperatively. Macular perfusion was evaluated by fluorescein angiography, preoperatively. Mean BCVA was 1.14 +/- 0.51 LogMAR, preoperatively and 0.89 +/- 0.53 LogMAR 6 months postoperatively [P=0.005]. Mean preoperative macular thickness was 506 +/- 121.9 micro m which decreased to 318 +/- 90.5 micro m, postoperatively [P=0.001]. Vitrectomy with removal of the posterior hyaloid membrane appears to be beneficial in some cases of diffuse persistent diabetic macular edema with a taut premacular posterior hyaloid unresponsive to laser therapy. Careful selection of eyes with favorable preoperative clinical characteristics may improve surgical outcomes
Subject(s)
Humans , Macular Edema/surgery , Diabetes Mellitus , Macula Lutea/pathology , Prospective Studies , Tomography, Optical Coherence , Diabetes ComplicationsABSTRACT
To present a case of chorioretinitis sclopetaria with attached retina in spite of performing deep vitrectomy without retinopexy. A 10-year-old boy was referred due to air-gun injury to the left eye. Right eye had visual acuity of 20/16, MG, and normal slit lamp examination and fbndoscopy. In the left eye, visual acuity was count fingers at 50 cm, MG[+++], anterior segment examination revealed massive subconjunctival hemorrhage and chemosis. On B-Scan echography there was a suspicious retinal detachment. We performed standard pars plana deep vitrectomy with prophylactic band without endolaser retinopexy. The retina was attached until last follow up at 14 month. In spite of severe defects in the retina and choroid in chorioretinitis sclopetaria, retinal detachment does not usually occur due to spontaneous retinopexy and scar formation
ABSTRACT
To determine the incidence of retinopathy of prematurity [ROP] and to evaluate the possible neonatal risk factors for ROP among premature infants referred to Farabi Eye Hospital during 2000-2002.Newborn infants with gestational age [GA] 37 wk or birth weight [BW] 2500 g were included. The first eye examination was performed 4-9 weeks after birth. Data on possible risk factors include low birth weight, low gestational age, sepsis, supplemental oxygen therapy, blood transfusion, phototherapy, multiple pregnancy, and respiratory distress syndrome [RDS] were compared between the two groups of newborns with and without ROP. Univariate and multivariate analysis was performed.One hundred eighty five neonates were included in this study [110 male, 75 female]. Mean GA +/- SD was 31.64 +/- 2.67 wk and mean BW +/- SD was 1620.68 +/- 467.6 g. The incidence of ROP was 12.4% [95%0: 7.6%-17.2%] including 8.6% in threshold and 3.8% in prethreshold stages. ROP was present in 18.6% of neonates with GA < 32 wk and 29% of neonates with GA < 28 weeks. All ROP cases had GA 5 wk. Mean GA +/- SD was 29.39 +/- 2.16 wk in the ROP group and 3196 +/- 2.58 wk in the non-ROP group. [P< 0.001] Mean BW +/- SD was 1283.48 +/- 342.84 g in the ROP group and 1668.55 +/- 464.04 g in the non-ROP group. [P< 0.001] ROP was pesent in 20.5% of neonates with BW S 1500 g. All ROP cases had BW 2000 g. There was a significant association between blood transfusion and incidence of ROP [odds ratio= 3.75, P= 0.004], RDS [OR= 3.14, 0.041], and phothotherapy [OR= 2.86, P= 0.044] based on univariate analysis. There was no significant association between oxygen therapy and incidence of ROP. Based on multivariate logistic regression analysis, low GA was the only significant factor associated with high incidence of ROP. We suggest GA < 33 wk and BW < 2000 g as the best criteria for screening of high neonates for developing ROP. These criteria deserve further investigation
ABSTRACT
Purpose: to determine the long-term visual and mortality outcomes of Endoresection for treatment of malignant posterior choroidal melanoma
Methods: this before and after clinical trial included 20 eyes of 20 patients with a diagnosis of posterior choroidal melanoma confirmed by indirect ophthalmoscopy and A and B ultrasonography. All tumors were medium sized according to measures of Collaborated Ocular Melanoma Study and no one had extraocular metastases. After obtaining informed consent, the eyes underwent vitrectomy and Endoresection of the tumors. Characteristics of the patients and tumors, visual acuity before and after surgery, intraoperative and postoperative complications, and enucleation rates were recorded. Patients were followed for 22 to 108 months [mean: 67.4 +/- 36.1]
Results: of 20 patients, 13 [65%] were male. Mean age was 47.1 +/- 16 years. Overall, 5 [25%] eyes were enucleated including 2 eyes [10%] due to severe intraoperative bleeding, 1 eye [5%] due to recurrence of intraocular melanoma, 1 eye [5%] because of a new focus of the tumor, and 1 eye [5%] secondary to intolerable pain. Final visual acuity of 15 saved eyes was 201200 in one eye [6.7%], counting fingers in 8 eyes [52.3%], hand motion in 3 eyes [20%], and no light perception in 3 eyes [15%]
Conclusion: endoresection of posterior choroidal melanoma is a reasonable globe saving treatment modality. Distant metastasis of choroidal melanoma is an infrequent result of this procedure
ABSTRACT
Purpose: to determine the success rate of scleral buckling without retinopexy in patients with primary retinal detachment
Methods: in a before-after clinical trial, 24 patients who had primary retinal detachment with PVR grade A or B underwent scleral buckling surgery with encircling band without retinopexy
Results: sixteen [66.7%] patients were male and 8 [33.3%] were female. Mean age of the patients was 43.5 years [range, 22-73]. Seventeen [70.8%] were phakic and 7 [29.2%] were pseudophakic or aphakic. Anatomical success rate was 100% intraoperatively. However, within 1-14 weeks redetachment occurred in 11.8% of phakic and 43% of pseudophakic or aphakic eyes. Reattachment was achieved in 4 patients by SF6 injection and laser application. Overall, final success rate was 95.8%, but in phakic eyes, it was 100%. Only 1 pseudophakic eye required pars plana deep vitrectomy, endolaser, and SF6 injection. All cases who underwent reoperation had attached retina up to end of the study with mean follow up of 53 months
Conclusion: encircling scleral buckling surgery without retinopexy in phakic patients with primary retinal detachment and PVR grade A or B is safe with acceptable results but the results are guarded in pseudophakic or aphakic patients and needs more investigation
ABSTRACT
Purpose: to evaluate the significance of the presence of pigment granules in the anterior vitreous as a reliable indicator of retinal breaks in patients with acute symptomatic posterior vitreous detachment [PVD]
Methods: this cross sectional study included 209 phakic patients with acute symptomatic PVD. The patients underwent anterior vitreous examination and fundoscopy. Patients with diabetic retinopathy, intraocular hemorrhage, intraocular inflammation, previous ocular surgery, and ocular trauma were not included. The role of age, sex, floaters or flashing, presence of pigment in the vitreous and retinal break were assessed
Result: the study was performed on 209 patients including 85 males and 124 females. Mean age was 59.18 years [range, 33-72 years]. Thirty patients [14.3%] were found to have an associated retinal break, 27 of which also had pigment in the vitreous [90%]. PVD symptoms were floaters in 44%, floaters [and] flashing in 41.2%, and flashing in 14.8%. Symptoms in patients who had retinal breaks were floaters in 60%, floaters [and] flashing in 36.7%, and flashing in 3.3%
Conclusion: presence of pigment granules in the vitreous is a reliable indicator of retinal breaks in association with an acute PVD. Floaters were the most common presenting symptom in patients with retinal breaks