Posterior sub-tenon's bevacizumab injection in diabetic macular edema; a pilot study

Purpose: To evaluate the short-term results of sub-tenon's injection of bevacizumab in patients with clinically significant macular edema [CSME]

Methods: In this prospective non comparative interventional case series, sub-tenon's injection of 2.5 mg/0.1 ml bevacizumab was performed for eyes with CSME. Macular thickness and best corrected visual acuity measurements were performed before and one month after injections

Results: Nineteen eyes of twelve patients with a mean age of 59.8 +/- 5.7 years were evaluated. Thirteen eyes [68.4%] had center-involving macular edema. No significant difference was observed between pre- and post-injection central subfield retinal thickness measurements [P = 0.3]. Central subfield thickness measurements improved or remained unchanged in 13 eyes [68.4%]. Baseline BCVA of 0.48 +/- 0.35 LogMAR improved to 0.36 +/- 0.26 LogMAR after injection [P = 0.01]. Improvement of >2 lines in BCVA was found in 5 eyes [26.3%], and no eye lost >2 lines of BCVA. No complication associated with sub-tenon's injection was observed

Conclusion: Sub-tenon's injection of bevacizumab resulted in significant short-term visual improvement in eyes with CSME. Retinal thickness changes were not significant

[Results of transarterial chemoembolization [TACE] in a group of Iranian patients with hepatocellular carcinoma]

Background: hepatocellular carcinoma [HCC] is a primary liver cancer that frequently causes mortalities. Transarterial chemoembolization [TACE] is a new palliative treatment for advanced stages of HCC. In this study, we have assessed the results of TACE on a group of Iranian patients with advanced HCC treated at Imam Khomeini General Hospital

Materials and Methods: this was a case series, cohort study conducted on 36 patients with HCC who met the study criteria. Patients underwent two sessions of TACE at a 4-6 week interval. All patients underwent triphasic computerized scans [CT scan] before treatment and at six weeks after the second session

Results: after at least a one year follow up period, 20 [55.6%] patients died and 16 [41.7%] survived. Survival at 6 months was 58% and at 12 months, it was 33.3%. Post-TACE tumor necrosis [>50%] was significantly associated with 6 [p= 0.029] and 12 [p= 0.00] month survival. There was a significant association between 6 and 12 month survival and Okuda stage [p-V= 0.001 and 0.003], ascites [p-V = 0.058 and 0.012] and branch portal vein thrombosis [p-V= 0. 036 and 0.024]. There was no association of WHO criteria to 6 [p-V = 0.139] and 12 [p-V =0.139] month survival

Conclusion: tumor necrosis less than 50%, presence of ascites and thrombosis of the portal branches are associated with lower survival. Suitable selection and taking into consideration post-TACE tumor necrosis is suggested to enhance survival

Vitrectomy for posterior segment intraocular foreign bodies, visual and anatomical outcomes

To evaluate the visual and anatomic results and determine the prognostic factors after pars plana vitrectomy and posterior segment intraocular foreign body [IOFB] removal. This retrospective study reviews the patients' charts of 48 consecutive patients with posterior segment IOFB who underwent pars plana vitrectomy and IOFB removal over a 4-year period, recently. Association between visual outcome and various preoperative, operative, and postoperative variables was statistically analyzed. Data were analyzed with the paired t-test and the chi square test. Statistical significance was indicated by P < 0.05. The mean interval between the time of injury and IOFB removal was 24 +/- 43.1 days and 27 [53%] eyes underwent IOFB removal within 7 days of the injury. Nine [19.1%] patients achieved a visual acuity of 20/40 or better. An improvement of visual acuity of at least three lines occurred in 21 [44.6%] eyes and the vision remained unchanged in 15 [31.9%] eyes. Postoperative retinal detachment occurred in five [10.6%] eyes. Visual improvement was more likely to occur in eyes with lower levels of presenting visual acuity [P = 0.2]. Visual improvement was not associated with an entry site and IOFB location, lens injury, time to surgery, and pre- and post-operative retinal detachment. At the end of follow up, anatomical success was achieved in 97.9% of eyes. High anatomical success could be achieved after the removal of posterior segment IOFBs by vitrectomy, despite a delay in surgery. Poor visual outcome may be mainly due to the initial ocular injury

Intravitreal bevacizumab for pseudophakic cystoid macular edema; a systematic review

Cystoid macular edema [CME] is a major cause of decreased vision after complicated or uncomplicated cataract surgery. This paper reviews the use of intravitreal bevacizumab [IVB] injection for treatment of pseudophakic CME. In a literature search of all articles available on Medline and Scopus databases, 11 studies including one prospective and 4 retrospective studies, 4 case reports, one letter to editor and one review article were identified. All articles except one, reported the use of IVB for chronic CME unresponsive to at least one conventional treatment modality. The level of evidence for all studies was categorized as low or very low. Although intravitreal bevacizumab might be effective for many cases of pseudophakic CME, its use should be reserved for eyes unresponsive to conventional treatment modalities.

Isolates and antibiotic resistance of culture-proven endophthalmitis cases presented to a referral center in Tehran

To evaluate the spectrum of organisms causing endophthalmitis and their resistance pattern to standard antimicrobial agents. Medical records of culture positive eyes treated at Rassoul Akram Hospital for endophthalmitis during the past 5 years were reviewed. Specimens were obtained during pars plana vitrectomy or vitreous tap. Sixty-five isolates including 36 [55.4%] gram-positive organisms, 28 gram-negative organisms [43.1%], and 1 [1.5%] fungus were studied. The most common organism identified was Coagulase-negative staphylococcus in 16 eyes [24.6%]. Among the antibiotics available for intravitreal injection, the least antibiotic resistance was for vancomycin in gram-positive organisms and amikacin and ceftazidime in gram-negative isolates. Gram-positive isolates were the most prevalent organisms; however, a high isolation rate for gram-negative organisms was obtained. Considering that no single antibiotic provides coverage for all of the organisms, a combination therapy using vancomycin/amikacin or vancomycin/ceftazidime seems to be useful as the initial empiric treatment of suspected bacterial endophthalmitis