Nicotinic acid treatment for retinal vein occlusion

To evaluate the effect of nicotinic acid in management of retinal vein occlusions [CRVO or BRVO]. This prospective nonrandomized pilot study included 20 patients [21 eyes] with CRVO or BRVO that received nicotinic acid [3 g/day] for 3 months. A complete ophthalmologic examination uncorrected visual acuity [UCVA], best spectacle-corrected visual acuity [BSCVA], testing for a relative afferent pupillary defect [RAPD], slit-lamp examination, gonioscopy, intraocular pressure [IOP] measurement, fundoscopy and fundus photography was performed. Four patients did not appear for follow-up and hypersensitivity reaction to nicotinic acid and severe hyperglycemia happened in two patients. Therefore, the results of treatment in 16 eyes of 15 are reported. These patients had a mean age of 59.56 +/- 11.12 years. The average length of follow-up was 8.6 +/- 2.7 months. The mean BSCVA was 1.56 +/- 0.66 before treatment, 1.38 +/- 0.72 [p>0.05] at one month and 0.88 +/- 0.69 [p<0.01] at three months. The last BSCVA of all 16 eyes averaged 0.97 +/- 0.73 [p<0.01]. All patients had reduction of hemorrhagic events, cotton wool spots, edema in macula and disc, venous tortuosity, and dilation on basis of fundus photographs 3 months after treatment. Nicotinic acid usage provides enough time for development of collateral vessels, by induction of vasodilatation. Nicotinic acid use is tolerable and is related with mild systemic side effects.

Bilateral Terrien's marginal degeneration and posterior polymorphous dystrophy in a patient with rheumatoid arthritis

Purpose: To report an interesting case of concomitant bilateral Terrien's marginal degeneration-like corneal ectasia and posterior polymorphous corneal dystrophy in a young man with quiescent rheumatoid arthritis

Case Report: A 24-year-old man with history of rheumatoid arthritis presented with bilateral decreased vision since four years ago. Slit lamp examination revealed bilateral circumferential peripheral corneal thinning and bulging with vascularization and lipid deposition in addition to band-like lesions in descemet's membrane. Previous records revealed no gross corneal abnormalities up to 4 years ago. Corneal lesions were compatible with bilateral circumferential Terrien's marginal degeneration concomitant with posterior polymorphous dystrophy

Conclusion: To our knowledge, this is the first report of concomitant bilateral Terrien's marginal degeneration with peripheral corneal ectasia and posterior polymorphous dystrophy in a patient with rheumatoid arthritis. Bilateral circumferential involvement, younger age at presentation and total peripheral corneal ectasia as observed in this case are not typical for classic Terrien's marginal degeneration

Indications for corneal transplantation at a tertiary referral center in Tehran

To report the indications and techniques of corneal transplantation at a tertiary referral center in Tehran over a 3-year-period. Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran form March 2004 to March 2007 were reviewed to determine the indications and types of corneal transplantation. During this period, 776 eyes of 756 patients [including 504 male subjects] with mean age of 41.3 +/- 21.3 years underwent corneal transplantation. The most common indication was keratoconus [n=317, 40.8%], followed by bullous keratopathy [n=90, 11.6%], non-herpetic corneal scars [n=62, 8.0%], infectious by corneal ulcers [n=90, 11.6%], non-herpetic corneal scars [n=317, 40.8%] followed by bullous keratopathy [n= 61, 7.9%], previously failed grafts [n=61, 7.9%], endothelial and stromal corneal dystrophies [n=28, 3.6%], and trachoma keratopathy [n=26, 3.3%]. Other indications including Terrien's marginal degeneration, post-LASIK keratectasia, trauma, chemical burns, and peripheral ulcerative keratitis constituted the rest of cases. Techniques of corneal transplantation included penetrating keratoplasty [n=607, 78.2%], deep anterior lamellar keratoplasty [n=108, 13.9%], conventional lamellar keratoplasty [n=44, 5.7%], automated lamellar therapeutic keratoplasty [n= 8, 1.0%], and Descemet stripping endothelial keratoplasty [n=6, 0.8%] in descending order. The remaining cases were endothelial keratoplasty and sclerokeratoplasty. In this study, keratoconus was the most common indication for penetrating keratoplasty which was the most prevalent technique of corneal transplantation. However, deep anterior lamellar keratoplasty is emerging as a growing alternative for corneal pathologies not involving the endothelium

Cataracts in diabetic patients: a review article

The number of people with diabetes mellitus is increasing and cataracts are one of the most common causes of visual impairment in these subjects. Advances in cataract surgical techniques and instrumentation have generally improved the outcomes; however, surgery may not be safe and effective in certain individuals with pre-existing retinal pathology or limited visual potential. This review article aims to address different aspects surrounding cataracts in diabetic patients. In a computerized MEDLINE search, relevant studies were selected by two authors using the keywords "diabetes mellitus", "cataract", "diabetic retinopathy" and "diabetic maculopathy"