[Randomized trial of intravitreal clindamycin and dexamethasone versus pyrimethamine, sulfadiazine, and prednisolone in treatment of ocular toxoplasmosis]

To compare the efficacy of intravitreal clindamycin and dexamethasone with classic treatment for ocular toxoplasmosis. In this prospective, randomized single-masked clinical trial a total of 68 patients with active ocular toxoplasmosis were assigned randomly to 2 treatment groups: 34 in the intravitreal clindamycin plus dexamethasone [IVCD] group and 34 in the classic treatment [CT] group. The IVCD group received 1 to 3 injection[s] of 1 mg intravitreal clindamycin and 400 microg dexamethasone, and the CT group received 6 weeks of treatment with pyrimethamine and sulfadiazine plus prednisolone. Antitoxoplasmosis antibodies [immunoglobulin [Ig] M and IgG] were measured using an enzyme-linked immunosorbent assay. The mean number of injections in the IVCD group was 1.6. Lesion size reduction was statistically significant after treatment in both IVCD and CT groups [P< 0.001 and P: 0.009, respectiveiy]. The difference in mean percentage of reduction at 6 weeks was not significant: 57 +/- 27.6% in the IVCD group versus 58.4 +/- 29.3% in the CT group. In comparison to baseline, VA increased by 0.44 +/- 0.24 and 0.29 +/- 0.19 logarithm of the minimum angle of resolution units in the IVCD and CT groups, respectively [P< 0.001]; however, the difference in VA improvement between the groups was not significant. The interaction effect of IgM and treatment group on lesion size reduction was significant [P= 0.002]; this indicated that IgM-positive cases responded better to CT and IgM-negative cases responded better to IVCD treatment. Vitreous inflammation reduction was comparable between the groups. Within 2 years, 4 eyes [2 in each group] had 1 episode of recurrence. Adverse drug reactions occurred in 2 patients in the CT group. No major injection-related complication was encountered in the IVCD group. Intravitreal injection of clindamycin and dexamethasone may be an acceptable alternative to classic treatment in ocular toxoplasmosis. It may offer more convenience, a safer systemic profile, greater availability, and fewer follow-up visits and hematologic evaluations

[Using asymmetric mixed bivariate modeling for comparing diabetic macular edema treatments according to visual acuity and central macular thickness outcomes]

One of the major causes of visual acuity loss in diabetic patients is diabetic macular edema [DME]. Best-corrected visual acuity and central macular thickness changes are considered as two main outcomes in diabetic macular patients. The goal of this study was to compare the effect of intravitreal bevacizumab injection alone or combined with triamcinolone versus macular photocoagulation as primary treatment for diabetic macular edema according to the clinical trial data sets. A new method was proposed to determine the best treatment for DME; i.e. intravitreal bevacizumab injection alone or combined with triamcinolone versus macular photocoagulation using asymmetric mixed modeling based on the recorded data in 97 diabetic patients. Effect of these treatments was investigated according to simultaneous investigation of visual acuity and central macular thickness as two major outcomes without omitting any outlier. The results of bivariate asymmetric mixed model revealed that intravitreal bevacizumab injection alone or combined with Triamcinolone treatments had more therapeutic effect than the macular photocoagulation in terms of increasing visual acuity and decreasing central macular thickness in patients with DME. Using asymmetric bivariate mixed model, there was a significant difference among the treatment modalities, duration of diabetes and gender in terms of visual acuity and central macular thickness

[Keratic precipitate morphology in various uveitic entities: a confocal scan study]

To characterize keratic precipitate [KP] morphology in different forms of uveitis. One hundred and twenty nine eyes of 93 patients with different forms of uveitis underwent confocal scan and the morphology of KPs were determined. Differences in KP morphologies among different uveitic groups were evaluated. Age ranged from 14 to 67 years [mean: 32.5 +/- 11.2] and 58 cases [62.36%] were female, 38.7% had bilateral uveitis. Almost all types of uveitis disclosed predominantly stippled and globular KPs. Dendritiform KPs were more common in infectious uveitis [P=0.053] and smooth-rounded KPs were significantly more common in non-infectious uveitis [P<0.001]. Dendritiform KPs were observed more commonly in nongranulomatous uveitis than granulomatous ones [P=0.005]. Smooth-rounded KPs were more common in chronic uveitis than acute forms [P<0.001]. The predominant morphology of KPs in Fuchs heterochromic iridocyclitis [FHIC] were dendritiform [80.0%] and infiltrating [78.0%]. The most commonly observed morphology of KPs in intermediate uveitis were dendritiform [56.3%] and smooth-rounded [56.3%]. Cruciform KPs were more frequently seen in cases with FHIC [60.0%]. Morphologic features in bilateral cases were similar. KP morphologies are diverse in different forms of uveitis. Some forms of KPs are less specific such as globular and stippled which exist in almost all types of uveitis. Confocal scan can play a potential role in differentiating infectious from noninfectious uveitis and granulomatous from nongranulomatous uveitis

[Randomized trial of intravitreal bevacizumab alone or combined with triamcinolone versus macular photocoagulation in diabetic macular edema]

To compare the results of intravitreal bevacizumb [IVB] injection alone or in combination with intravitreal triamcinolone acetonide [IVT] versus macular laser photocoagulation [MPC] as primary treatment of diabetic macular edema [DME]. In this randomized clinical trial, 150 eyes of 129 patients with clinical DME and no previous treatment were enrolled. The eyes were randomly assigned to one of the three study arms: the IVB group received 1.25 mg IVB [50 eyes]; the IVB/IVT group received 1.25mg of IVB and 2 mg of IVT [50 eyes]; and the MPC group underwent focal or modified grid laser [50 eyes]. Retreatment was performed at 12-week intervals whenever indicated. Visual acuity [VA] changes among the groups were statistically significant at 6 [P<0.001] and 24 [p=0.012] weeks. VA change was significant only in the IVB group at 12 weeks. VA changes +/- standard deviation at 36 weeks were -0.28 +/- 0.25, -0.04 +/- 0.33, and +0.01 +/- 0.27 LogMAR in the IVB, IVB/IVT, and MPC groups, respectively [P=0.053]. Significant reduction in central macular thickness [CMT] was observed in all groups only up to 6 weeks; however, CMT changes were not significantly different among the groups in all visits. Overall, retreatment was required for 27 eyes up to 36 weeks [14 in the IVB group, 10 in the IVB/IVT group, and 3 in the MPC group]. In the IVB group, in which greater VA improvement was observed, only one injection was required in 72% of the cases. VA improvement more than 2 Snellen lines at 36 weeks occurred in 37%, 25%, and 14.8% of patients in the IVB, IVB/IVT and MPC groups, respectively. Intravitreal bevacizumab injection in patients with DME yielded a better visual outcome at 24 weeks compared with macular photocoagulation. After 6 weeks changes in CMT and VA were not compatible. No adjunctive effect of IVT was demonstrated

[Review of intravitreal implants for extended drug delivery to the posterior segment of the eye]

Intravitreal injection is the most common approach for drug delivery to the posterior segment in humans. However, following the injection, drugs are rapidly eliminated from the vitreous, with half-lives up to a few days. Depending on the rate of clearance from the vitreous, large boluses and frequent administrations may be required to ensure therapeutic levels over an extended period of time. Multiple intraocular injections can lead to an increased likelihood of complications, such as vitreous hemorrhage, retinal detachment, endophthalmitis and cataract. In order to decrease the occurrence of complications associated with intravitreal injections, sustained-release drug delivery systems are desired to provide drug release into the posterior segment for a longer period of time [months or even years] compared to direct injection. This article reviews the current status of various intravitreal implants, both approved and in clinical development. These implants are: Vitraset, Retisert, Ozurdex [Posurdex], I-vation, Iluvien [Medidur] and NT-501. A search of the English language PubMed database was conducted with keywords of "intraocular implant", "intravitreal implant", "sustained-release" and "intravitreal drug delivery"

[Intravitreal bevacizumab [avastin] injection alone or combined with triamcinolone versus macular photocoagulation as primary treatment for diabetic macular edema; an interim analysis]

To report the efficacy of a single intravitreal injection of bevacizumab [IVB] alone or in combination with intravitreal triamcinolone acetonide [IVT] versus macular laser photocoagulation [MPC] as primary treatment for diabetic macular edema [DME]. This randomized three-arm clinical trial included 103 eyes of 97 patients with clinically significant DME and no previous treatment. The eyes were randomly assigned to one of the three study arms: the IVB group received 1.25 mg IVB [37 eyes], the IVB/IVT group received 1.25 mg IVB together with 2 mg IVT [33 eyes], and the MPC group underwent focal or modified grid laser photocoagulation [33 eyes]. Primary outcome measure was change in best-corrected visual acuity [BCVA]. Changes in BCVA [logMAR] at 12 weeks were -0.22 +/- 0.23, -0.13 +/- 0.31 and +0.08 +/- 0.31 in the IVB, IVB/IVT and MPC groups, respectively. The marginal regression model based on generalized estimating equation analysis demonstrated that changes in visual acuity was statistically significant in the IVB group at both 6 [P<0.001] and 12 [P=0.024] weeks but only at 6 weeks in the IVB/IVT group. Significant decrease in central macular thickness [CMT] was observed in the IVB and IVB/IVT groups at 6 weeks. Up to 12 weeks, IVB treatment in eyes with DME yielded better visual outcome than laser photocoagulation, although it was not associated with a significant decrease in CMT. IVT seemed to have no further beneficial effect in combination with IVB

[Vitrectomy with internal limiting membrane peeling in acute central retinal vein occlusion presenting with low vision]

To evaluate the visual and anatomical outcomes of pars plana vitrectomy and indocyanine green [ICG] assisted internal limiting membrane [ILM] peeling in fresh central retinal vein occlusion [CRVO] with primary low vision. In a prospective interventional case series, 15 eyes of 15 patients with fresh CRVO [less than 3 months' duration] and presenting best-corrected visual acuity [BCVA] less than 20/200, underwent standard 3-port pars plana vitrectomy and ICG assisted ILM peeling. BCVA and central macular thickness [CMT] by optical coherence tomography [OCT] were evaluated 2 weeks and 1, 2, 4 and 6 months postoperatively and when needed thereafter. The patients included 8 male and 7 female subjects with mean age of 54.7 +/- 11.9 [range 29-75] years. Mean duration of symptoms at the time of surgery was 51.7 +/- 17.8 [range 26-85] days. CRVO was ischemic in 12 eyes [80%] and non-ischemic in 3 eyes [20%]. Patients were followed for 9.5 +/- 4.8 [range 6-23] months. Mean BCVA [logMAR] was 1.86 +/- 0.37 at presentation which improved to 1.65 +/- 0.40 at 2 weeks [P=0.23], 1.68 +/- 0.39 at one month [P=0.095], 1.60 +/- 0.46 at 2 months [P=0.069], 1.72 +/- 0.72 at 4 months [P=0.423], 1.58 +/- 0.69 at 6 months [P=0.140] and 1.42 +/- 0.37 at last visit [P=0.006]. Mean CMT was 605.5 +/- 279.2 +/- m preoperatively which was decreased to 527.4 +/- 274.3 microm at 2 weeks [P=0.371], 624.4 +/- 336.7 microm at one month [P=0.773], 546.4 +/- 344.9 microm at 2 months [P= 0.491], 343.3 +/- 256.9 microm at 4 months [P=0.250], 369.3 +/- 207.5 microm at 6 months [P=0.078] and 368.9 +/- 199.0 microm at final visit [P=0.03]. Pars plana vitrectomy with ILM peeling in patients with fresh CRVO and low presenting visual acuity [<20/200] may improve visual acuity and decrease in CMT in long-term follow-up, but does not seem to have any significant effect in comparison to the natural course of CRVO. Certain postoperative complications such as vitreous hemorrhage are relatively common requiring repeat vitreoretinal surgery. Therefore, we do not recommend this procedure for such patients

[ Confocal Scan Features of Keratic Precipitates in Fuchs' Heterochromic Iridocyclitis]

To report confocal scan features of keratic precipitates [KPs] in Fuchs' heterochromic iridocyclitis [FHIC]. In this descriptive study, corneal confocal scan was performed to characterize KPs in patients with FHIC referred to Labbafinejad Medical Center from November 2005 to March 2007. Polymerase chain reaction [PCR] for Herpes Simplex virus, Herpes Zoster virus, Toxoplasma gondii, Cytomegalovirus and Rubella virus was performed on aqueous humor samples taken in 4 patients who underwent phacoemulsification. Confocal scan was performed in 40 eyes of 34 patients including 18 male and 16 female subjects with mean age of 30.7 +/- 10.5 [range 18-57] years. FHIC was bilateral in 6 and unilateral in 28 patients. The distribution of KPs was diffuse in 31 eyes and limited to the inferior cornea in 9 eyes. The morphology of KPs included: globular, 34 eyes [85%]; infiltrating, 31 eyes [77.5%]; dendritiform, 31 eyes [77.5%]; stippled, 27 eyes [67.5%]; and cruciform, 25 eyes [62.5%]. None of the cases demonstrated smooth-rounded KPs. PCR of aqueous specimens was negative for the above-mentioned infectious agents in 4 eyes who had infiltrating and dendritiform KPs on confocal scan. Confocal features of KPs in FHIC are diverse and include globular, infiltrating and dendritiform, stippled and cruciform. Presence of infiltrating and dendritfrom KPs in FHIC may be suggestive of a possible infectious etiology, however the results of PCR were negative in the limited numbers of such patients in our series

[Intravitreal injection of bevacizumab versus triamcinolone acetonide in patients with refractory CME]

To compare intravitreal bevacizumab [IVB] with intravitreal triamcinolone acetonide [IVT] for treatment of refractory uveitic cystoid macular edema [CME]. In this randomized clinical trial, 31 eyes with uveitic CME were allocated into 2 groups: the IVB group, received one to three injections of 1.25 mg bevacizumab [15 eyes]; the IVT group received one to three injections of 2mg triamcinolone [16 eyes]. The primary outcome measure was change in best-corrected visual acuity [BCVA] at 36 weeks. Visual acuity improvement as compared to baseline values was meaningful in the IVB group at 12, 24, and 36 weeks and in the IVT group at 24 and 36 weeks. A significant reduction in central macular thickness [CMT] was observed only in the IVT group at week 36 [74.6?108.0 microm [P=0.049]]. Intergroup analysis however, disclosed no significant difference in any of the outcome measures. By removing the effect of cataracts, IVT had a better improving effect on VA [P=0.007]. No significant systemic side effect was observed during the study period. IVB was as effective as IVT in refractory uveitic CME regarding VA improvement. Irrespective of triamcinolone-induced cataract, the effect of IVT may be superior to IVB

[Combined hamartoma of the retina and retinal pigment epithelium in a patient with fundus flavimaculatus]

To report a patient with fundus flavimaculatus or macular dystrophy with flecks, who came to medical attention due to deteriorated vision in one eye and combined hamartoma of the retina and retinal pigment epithelium. A 26 year old lady was referred with history of progressive decreased vision in both eyes since childhood with recently deteriorated vision in her right eye. In the last examination, visual acuity with correction was 20/400 in the right and 20/200 in the left eye. On biomicroscopic funduscopy, there was a mass-like lesion extending all over the macula in the right eye with distortion of the fundus and retinal vasculature. A thick epiretinal fibrous membrane covered the lesion. Left eye examination revealed lack of foveal reflex with an atrophic retina, retinal pigment epithelium and choriocapillaris accompanied by pigmentary changes. Diffuse flecks extended from the macula to the mid periphery. Elecroretinogram and electrooculogram confimed a diagnosis of advanced fundus flavimaculatus. Fluorescein angiography and indocyanine green imaging did not show any evidence of choroidal neovascularization. There has been no report of concurrent macular dystrophy with flecks and combined hamartoma of the retina and retinal pigment epithelium in the literature. It is not clear whether this is an accidental association or there may be genetic footprints

[Visual outcomes of 4 therapeutic approaches for central retinal vein occlusion]

To compare the visual outcomes of four different therapeutic modalities for central retinal vein occlusion [CRVO] with each other and with the natural course of the disease. This study was conducted on 63 eyes of 63 patients including 13 eyes in the radial optic neurotomy [RON] group, 10 eyes in the combined RON and intraocular triamcinolone injection [RON/IOT] group, 12 eyes in the combined internal limiting membrane peeling, RON and IOT [ILMP/RON/IOT] group, 14 eyes in the intravitreal triamcinolone injection [IVT] group and 14 untreated control eyes. All patients were followed for six months. Final best-corrected visual acuity [BCVA] was better in the IVT group as compared to the RON [P=0.037], RON/IOT [P=0.401], ILMP/RON/IOT [P=0.023] and control [P=0.025] groups. However, after adjusting final BCVA for baseline BCVA, only the RON/IOT group showed significant visual improvement after 1 [P= 0.025], 3 [P= 0.023] and 6 [P= 0.054] months as compared to controls. Among the four different approaches evaluated in this study, RON/IOT may entail better visual outcomes in the management of CRVO within six months

[Combined sutureless 25-gauge vitrectomy, phacoemulsification, and posterior chamber intraocular lens implantation for management of uveitic cataracts associated with posterior segment disease]

To report the visual outcomes and complication of one-stage surgery for management of uveitic cataracts associated with posterior segment disease. In this retrospective interventional case series, 19 eyes of 19 patients with posterior segment involvement due to chronic uveitis underwent sutureless scleral tunnel incision phacoemulsification combined with total vitrectomy using 25-gauge instruments and posterior chamber intraocular lens [PCIOL] implantation. Membrane peeling and endolaser photocoagulation were performed when indicated. Outcome measures were visual acuity, inflammatory activity, macular edema and surgical complications. After a minimum 12-month follow-up, visual acuity was >/=20/100 in 12 eyes [63.2%] and >/=20/40 in 6 eyes [31.6%]. One grade of decrease in postoperative inflammatory activity was observed in 8 eyes [42.1%]. Cystoid macular edema was present in 16 eyes preoperatively and in 12 eyes postoperatively. Early postoperative complications included transient corneal edema in 10 eyes [50.3%], posterior synechia in 9 eyes [47.3%] and fibrin reaction in 3 eyes [15.8%]. Glaucoma was the most common late postoperative complication [3 eyes, 18.8%]. Nine eyes [47.4%] needed YAG laser capsulotomy during the first year. Combined sutureless 25-gauge vitrectomy, phacoemulsification, and PCIOL implantation may be a well tolerated procedure with an acceptable complication rate for visual restoration in selected uveitic eyes with significant cataract and coexisting posterior segment disease

[Histopathologic evaluation of optic neurotomy with MVR blade and excimer laser in cadaver eyes]

To evaluate the histopathologic features of optic neurotomy with microvitreoretinal [MVR] blade and excimer laser in cadaver eyes. Optic neurotomy was performed in 11 cadaver eyes using 20-gauge MVR blade and in three cadaver eyes with pulsed xenon chloride [XeCl] excimer laser [308 nm] via monofile lightconducting fiber with a core diameter of 200 microns. After tissue processing, hematoxylin and eosin stained slides were used to evaluate the posterior segment of the globes, including the optic nerve head. None of the cases in the MVR neurotomy group had scleral macro- or micro-perforation and no injury was induced to the central retinal vein or artery. In 10 cases, the distance between the neurotomy site and the central retinal vessels ranged from 50 to 500 micro at all histologic levels. In one remaining case this distance was approximately 10 micro on two histologic sections and about 200 micro at a third level. Intra-neural hemorrhage was found in 18% of cases. Neurotomy was successfully induced in two of three cases attempted with the excimer laser. In one case, due to cloudy media, it was not apparent whether the laser successfully induced the neurotomy and no neurotomy was evident on sectioning. MVR induced optic neurotomy is an effective procedure to create scleral outlet relaxation, without significant surgical complications such as scleral perforation or central retinal vascular injury. This preliminary study also demonstrates that the XeCl excimer laser can make nonmechanical cuts with relative ease and reliability

Causes and results of vitrectomy for spontaneous non-diabetic vitreous hemorrhage

To determine the visual and anatomical outcomes and complications of vitrectomy for non-traumatic non-diabetic vitreous hemorrhage [NDVH] and to report the causes of the condition among patients at Labbafinejad Medical Center, Tehran-Iran, from 1993 to 2003. Records of patients who underwent vitrectomy for non-traumatic NDVH with 6 months follow up were reviewed for demographic characteristics, causes of NDVH and results of surgery. Fifty eyes [54.2% right eyes] of 49 patients [51% male] with mean age of 62.7 +/- 10.3 years were enrolled in the study. Mean visual acuity [VA] was 2.36 +/- 0.52 LogMAR and relative afferent pupillary defect [RAPD] was positive in 91.7% of the eyes, preoperatively. Causes of non-traumatic NDVH detected intraoperatively were: branch retinal vein occlusion [56%], central retinal vein occlusion [16%], choroidal neovascularization [12%], and posterior vitreous detachment with break, Eales disease, familial exudative vitreoretinopathy, and Terson syndrome [each in 4%]. Mean VA increased significantly at 6th month [1.38 +/- 0.72 IogMAR] compared to preoperative value. [P<0.0001] The most common causes of decreased VA were: macular pigmentary derangement [26%], optic atrophy [16%], severe lens opacity [12%], and epiretinal membrane [8%]. Despite the statistically significant increase in mean VA following vitrectomy, underlying macular pathology limits significant improvement of central VA in most cases of non-traumatic NDVH

Clinical aspects and results of lensectomy in hereditary lens subluxation

To evaluate the clinical manifestations and results of lensectomy in patients with hereditary lens subluxation at Labbafinejad Medical Center, Tehran-Iran from 1996 to 2003. In an interventional case series, records of patients with hereditary lens subluxation who had undergone lensectomy were reviewed. Patients with at least 6 months of follow up were included. Background disease, best corrected visual acuity [BCVA] before and after surgery, intraocular pressure [IOP], and post-operative refraction and complications were evaluated. The study was performed on 87 eyes of 49 patients including 27 male and 22 female subjects. Mean follow up was 20 +/- 18 months. Marfan syndrome [79.5%], Weill-Marchesani syndrome [8.2%], 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 preoperatively which improved to 0.26 Log MAR post-operatively [P< 0.001]. BCVA better than 20/40 was achieved in 82.8% of cases after surgery. Angle-supported anterior chamber intraocular lens [AC IOL] was implanted in 85.1% of the eyes. Prophylactic band was applied in 63 eyes [72.4%]. Retinal detachment developed in four eyes, which was successfully treated. Lensectomy with implantation of angle-supported AC IOL in patients with hereditary subluxated lens will improve vision significantly without significant complications

Pediatric Vogt-Koyanagi-Harada [VKH]-Associated Panuveitis: Clinical Course and Management

To assess the clinical course, determine the efficacy and safety of oral methotrexate in the control of intraocular inflammation and evaluate the outcomes of lensectomy-vitrectomy and goniosynechiolysis in pediatric VKH-associated panuveitis. In this retrospective non-comparative interventional case series, 10 patients [20 eyes] with pediatric VKH-associated panuveitis [onset of disease at age 14 years or younger] were studied. All patients underwent stepwise medical treatment consisting of oral prednisolone [0.5-1 mg/kg], supplemented by oral methotrexate [5-7.5 mg/wk] in refractory cases. Surgical intervention was performed for complications such as visually significant cataracts and secondary glaucoma and included pars plana lensectomy-vitrectomy and peripheral anterior synechiolysis in a one-stage procedure. Control of inflammation, corticosteroid requirement, visual acuity, and intraocular pressure [IOP] were the main outcome measures. Ten consecutive patients with minimum follow up of six months were analyzed. All patients were initially treated with oral corticosteroids; methotrexate was additionally required in six subjects. In all eyes, inflammation decreased and vision was preserved or improved. Side effects of methotrexate were mild and transient. Nine eyes of five patients underwent combined lensectomy and vitrectomy. The procedure was successful in all eyes without any exacerbation of inflammation. Eight eyes had elevated IOP, six of which underwent peripheral anterior synechiolysis at the time of lensectomy-vitrectomy. IOP was controlled after the procedure in all eyes with timolol only. Overall, final visual acuity was

Results of vitrectomy in idiopathic Macular Hole

To evaluate the visual and anatomical outcomes and complications of vitrectomy with or without removal of internal limiting membrane [ILM] in idiopathic macular hole [IMH] at Labbafinejad Medical Center, Tehran-Iran, 1993-2003. Hospital records of patients who had undergone vitrectomy for IMH and completed 6 months of follow up were reviewed for demographic data and outcomes of surgery .The study was conducted on 30 eyes [46.7% right eyes] of 29 patients [69% female] with mean age of 65.2 +/- 5.6 years. Mean duration of symptoms was 3.2 +/- 3.7 months [66.7% less than 6 months]. Preoperatively macular holes were in stages 2, 3, and 4 in 3.0%, 36.7%, and 33.3%, respectively. ILM removal was performed in 21 eyes [70%]. Mean visual acuity was 099 +/- 0.6 LogMAR preoperatively which reached to 0.87 +/- 0.39 LogMAR postoperatively [P=0.05]. Single operation anatomical success rate was 80% [24 eyes] and final success rate was 86.7% [26 eyes]. Retinal breaks developed in 3 eyes [10%] intraoperatively. ILM removal had no effect on increasing the rate of macular hole closure. ILM removal has no significant role on closure of IMH with less than 6 months of duration

[Agreement between quantitative analysis of fundus and angiographic images by Photoshop software and clinical judgment]

To evaluate the agreement between a new method for quantitative analysis of fundus or angiographic images using Photoshop software and clinical judgment. Four hundred evaluated by three retina variables were selected for eighteen fundus and angiographic images of diabetic patients were specialists and then by computer using Photoshop 7.0 software. Four amount of hard exudates [HE] on color pictures, amount of HE on red-free pictures, severity of leakage, and size of foveal avascular zone. Available programs in the software such as color selection, luminosity channel, and histogram and tools such as magnetic lasso and magic wand were used for measurement. Coefficients of agreement and kappa measurements were calculated. Agreement [kappa] between the two methods in the amount of HE on color and red-free photographs were 85% [0.69] and 79% [0.59], respectively. This agreement for severity of leakage was 72% [0.46]. In the evaluation of the foveal avascular zone size with two methods of quantification using the magic and lasso software tools the agreement was 54% [0.09] and 89% [0.77], respectively. Quantitative measurement of fundus and angiographic image variables such as HE, leakage, and foveal avascular zone can be performed precisely using Photoshop software

Radial Optic Neurotomy with and without Intravitreal Triamcinolone Injection in Central Retinal Vein Occlusion

To evaluate the efficacy of radial optic neurotomy [RON] combined with or without intravitreal triamcinolone acetonid [IVTA] injection in the management of central retinal vein occlusion [CRVO].This non-randomized clinical trial was conducted on 23 patients with CRVO, who underwent RON with or without IVTA injection. Preoperative and postoperative best corrected visual acuity were converted to LogMAR and time to plateau of best corrected visual acuity were evaluated over a 12 months period. The patients included 16 male and 7 female subjects with mean age of 56 +/- 16.8 year [25-72 years]. Mean visual acuity was 1.42 +/- 0.43 LogMAR [20/600] preoperatively, which improved to 1.1 +/- 0.14 LogMAR [20/250] postoperatively. [P< 0.05] At one year, mean visual acuity was 1.56 +/- 0.63 LogMAR in the non-IVTA group and 1.09 +/- 0.37 LogMAR in the IVTA group [P= 0.04]. Vision improved by 3 or more lines in 14 eyes [60.9%]. Overall eyes with combined RON and IVTA injection had better postoperative visual acuity, although it was not statistically significant. Time to plateau of best-corrected visual acuity in eyes that underwent RON combined with 1VTA injection was significantly shorter. The combination of RON and IVTA injection may enhance therapeutic success and cause faster visual rehabilitation than RON alone

Medulloepithelioma Masquerading as Chronic Granulomatous Uveitis

To report a case of ciliary body medulloepithelioma presenting as granulomatous uveitis.A 3-year-old girl presented with chronic granulomatous anterior uveitis in the right eye following unilateral cataract extraction and IOL implantation which was unresponsive to topical steroids and intra-vitreal injection of vancomycin and triamcinolone acetonide. One month later, white masses appeared over the iris surface. Histopathologic examination of the iris biopsy disclosed ciliary body medulloepithelioma. The patient was referred for plaque therapy due to the aggressive behavior of the tumor and finally, the eye was enucleated due to getting blind and painful and high suspicious of malignant behavior of the tumor. Medulloepithelioma is a rare congenital ciliary body tumor that presents with decreased vision, pain, leukocoria, and observation of a mass in the region of the ciliary body, anterior chamber and iris. Secondary glaucoma, cataract, uveitis, rubeosis iridis, retinal detachment, and ectopia lentis may develop later. The tumor may be locally aggressive and rarely metastasize. If extraocular extension does not occur, iridocyclectomy with tumor excision [in small tumors] and enucleation [in large tumors] appears to be the treatment of choice