Predictors and Outcomes of Vitrectomy and Silicone Oil Injection in Advanced Diabetic Retinopathy

PURPOSE: To evaluate visual and anatomical results and identify factors that influence vitrectomy and silicone oil (SO) injection outcomes in proliferative diabetic retinopathy (PDR). METHODS: This retrospective study included 236 eyes with PDR that were undergoing vitrectomy and SO injection with >3-month follow-up. The primary outcomes were final best-corrected visual acuity (BCVA) and retinal attachment rate. RESULTS: At the final visit (mean, 88 ± 58 weeks), complete, partial, and no retinal attachment were observed in 86.9%, 10.6%, and 2.5% of patients, respectively. A total of 155 eyes had experienced SO removal, while 81 had SO in place. The mean initial BCVA was 1.9 ± 0.7 logarithm of the minimum angle of resolution (logMAR) and significantly improved to 1.7 ± 0.8 logMAR (p = 0.001). Initial macular detachment (adjusted odds ratio [AOR], 0.25), development of iatrogenic break (AOR, 0.25), and use of heavy SO (AOR, 0.13) were independently associated with a lower risk of final retinal attachment, and SO removal was associated with a higher incidence (AOR, 7.55). Better baseline BCVA was associated with a higher risk of final BCVA ≥20 / 200. CONCLUSIONS: Despite an encouraging outcome based on anatomical data in advanced PDR treated with vitrectomy and SO, the functional prognosis was not satisfying for patients. Eyes with better vision at baseline had a more favorable prognosis, whereas eyes with initial macular detachment, intraoperative iatrogenic break, or heavy SO showed more unfavorable outcomes. In selected cases, extending the time of SO use did not worsen the prognosis.

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

Intravitreal triamcinolone for acute branch retinal vein occlusion: a randomized clinical trial

To evaluate the therapeutic effect of intravitreal triamcinolone [IVT] injection for recent branch retinal vein occlusion [BRVO]. In a randomized controlled clinical trial, 30 phakic eyes with recent [less than 10 weeks' duration] BRVO were assigned to two groups. The treatment group [16 eyes] received 4 mg IVT and the control group [14 eyes] received subconjunctival sham injections. Changes in visual acuity [VA] were the main outcome measure. VA and central macular thickness [CMT] changes were not significantly different between the study groups at any time point. Within group analysis showed significant VA improvement from baseline in the IVT group up to three months [P < 0.05]; the amount of this change was 0.53 +/- 0.46, 0.37 +/- 0.50, 0.46 +/- 0.50, and 0.29 +/- 0.45 logMAR at 1, 2, 3, and 4 months, respectively. Corresponding VA improvements in the control group were 0.20 +/- 0.37, 0.11 +/- 0.46, 0.25 +/- 0.58, and 0.05 +/- 0.50 logMAR [all P values > 0.05]. Significant reduction in CMT was noticed only in the treatment group [-172 +/- 202 micro m, P = 0.029] and at 4 months. Ocular hypertension occurred in 4 [25%] and 2 [14.3%] eyes in the IVT and control groups, respectively. A single IVT injection had a non-significant beneficial effect on VA and CMT in acute BRVO as compared to the natural history of the condition. The 3-month deferred treatment protocol advocated by the Branch Vein Occlusion Study Group may be a safer option than IVT injection considering its potential side effects

Early onset optic neuritis following measles-rubella vaccination

To report two cases of optic neuritis with onset less than 24 hours following measles-rubella [MR] vaccination. Two teenage patients developed acute optic neuritis 6 to 7 hours after MR booster vaccination. The first patient demonstrated bilateral papillitis and severe visual loss but improved significantly with pulse intravenous steroid therapy with methylprednisolone 500 mg/day. The second patient had unilateral retrobulbar optic neuritis and demonstrated excellent visual recovery without intervention. Acute optic neuritis is a rare complication of MR vaccination and may occur early after immunization

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