[Topical sodium diclofenac during pan-retinal photocoagulation in patients with proliferative diabetic retinopathy]

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

[Long-term results of Endoresection of posterior choroidal melanoma]

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

[Scleral buckling without retinopexy in primary retinal detachment]

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

[Correlation between presence of pigment granules in the vitreous and retinal breaks in patients with acute symptomatic posterior vitreous detachment]

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

[Alport syndrome: report of three cases in one family]

Purpose: to report three cases of Alport syndrome in one family with anterior lenticonus and retinal flecks

Patients and findings: three members of one family with consanguineous parents are presented who had renal and ocular involvement. They had anterior lenticonus and a beaten bronze appearance in the macula. Reduced visual acuity and photophobia were the chief complaints of these patients. Despite correction of her refractive error, one of them underwent clear lens extraction with intraocular lens implantation due to severe impairment of visual acuity. Two patients had severe renal failure with subsequent renal transplantation. Biopsy of one of them confirmed the diagnosis of Alport syndrome

Conclusion: despite the rarity of ocular involvement in Alport syndrome, especially in females, all three patients had anterior lenticonus and retinal flecks. Regardless of macular involvement, the main cause of decreased visual acuity was lenticular anomaly. Clear lens extraction with intraocular lens implantation was an effective treatment modality in these patients