Preoperative injection of intravitreal bevacizumab in dense diabetic vitreous hemorrhage.

PURPOSE: To evaluate the effect of preoperative intravitreal injection of bevacizumab on surgery and on the early postoperative course in diabetic patients undergoing vitrectomy for dense vitreous hemorrhage. METHODS: Thirty-five patients with dense diabetic vitreous hemorrhage were randomly assigned to a group that received 1.25 mg of intravitreal bevacizumab 1 week before vitrectomy (18 patients) or the control group (17 patients). To compare the complexity of two groups, intraoperative complexity score and proliferative diabetic vitreoretinopathy stage were recorded. Intraoperative bleeding, break formation, number of endodiathermy applications, best-corrected visual acuity, anatomical outcome at Month 3 and at final follow-up, and postoperative complications were evaluated. RESULTS: Mean complexity scores and proliferative diabetic vitreoretinopathy stages of both groups were similar. The mean score of bleeding was 1.05 in the injection group versus 1.76 in the control group (P = 0.35); endodiathermy applications and break formations were 0.44 versus 0.52 (P = 0.68) and 0.22 versus 0.29 (P = 0.60) in the injection and control groups, respectively. Anatomical outcome and visual acuity at Month 3 and at the final follow-up were similar. CONCLUSION: The results suggest that intravitreal injection of bevacizumab before vitrectomy for dense diabetic vitreous hemorrhage has no significant effect on facilitation of surgery or on the early postoperative course.

Susac's Syndrome in a 27-Year-Old Female.

A 27-year-old woman was referred by the neurologist for ophthalmic examination. She had a history of headache, visual loss in her right eye, four-limb paresthesia, and behavioral changes over the previous 10 months. The patient complained of tinnitus and hearing loss for two weeks. The patient was initially diagnosed with multiple sclerosis, but auditory and retinal involvement (small branch retinal artery occlusion in fluorescein angiography) raised the possibility of Susac's syndrome.

Long-term effect of dalteparin in the prevention of neovascularization of iris in recent-onset central retinal vein occlusion.

BACKGROUND: To compare the long-term effect of dalteparin in the prevention of neovascularization of iris in recent-onset central retinal vein occlusion with that of aspirin. METHODS: A randomized controlled clinical trial was conducted on patients with central retinal vein occlusion of less than 30 days duration. Patients in the dalteparin group received subcutaneous dalteparin 100 IU/kg twice a day for 10 days, and then 100 IU/kg once a day for another ten days. In the aspirin group the patients received 100 mg aspirin daily throughout the study. RESULTS: Forty seven patients were enrolled, 24 in the dalteparin group and 23 in the aspirin group, and were followed up for one year. One (4.1%) of the 24 patients in dalteparin group, and 9 (39.1%) of 23 patients in aspirin group developed iris neovascularization. the difference was significant (P=0.0001). The visual outcomes of the two groups were compared, and a significant difference was found (P=0.016). CONCLUSION: Patients treated with dalteparin within 30 days of the onset of central retinal vein occlusion were less likely to develop neovascularization of iris. There was also a significant difference in the visual acuity between two groups.

Dalteparin versus aspirin in recent-onset branch retinal vein occlusion: a randomized clinical trial.

BACKGROUND: Retinal vein occlusion is the second most common vascular disease of retina after diabetic retinopathy, affecting 1.6% of the population above the age of 40. The aim of this study was to compare the effect of dalteparin and aspirin in patients with recent-onset branch retinal vein occlusion. METHODS: A randomized clinical trial was conducted on patients with branch retinal vein occlusion of less than 30 days' duration. Ophthalmic, systemic, and hematologic evaluations were made. Visual acuity was measured with Early Treatment Diabetic Retinopathy Study chart. Patients in the dalteparin group received subcutaneous dalteparin 100 IU/kg twice daily for 10 days, then 100 IU/kg once daily for another 10 days while the patients in the aspirin group were given aspirin 100 mg daily throughout the study. RESULTS: Seventy-eight patients were enrolled, 37 in the dalteparin and 41 in the aspirin group. The patients were followed for six months. The visual outcomes of the two groups were compared. Although dalteparin improved mean visual acuity slightly more than aspirin, no statistically significant differences were found between the groups at one (P=0.37), two (P=0.16), three (P=0.11), or six (P=0.13) months. Resolution of macular edema and development of new vessels made no statistically significant difference between the groups [(P=0.08) and (P=0.49), respectively]. CONCLUSION: In recent-onset branch retinal vein occlusion, no significant difference was found in the final visual acuity between the patients treated by dalteparin or aspirin. A further study with larger sample size is recommended.

Intravitreal triamcinolone acetonide injection at the end of vitrectomy for diabetic vitreous hemorrhage: a randomized, clinical trial.

PURPOSE: To evaluate the clinical outcome and complications of intravitreal injections of triamcinolone acetonide in patients undergoing pars plana vitrectomy for treatment of diabetic nonclearing vitreous hemorrhage. PATIENTS AND METHODS: This prospective, randomized clinical trial study included 72 consecutive patients (72 eyes) who underwent pars plana vitrectomy for treatment of diabetic nonclearing vitreous hemorrhage. 38 patients received an intravitreal injection of 4 mg (0.1 cc) of triamcinolone acetonide at the end of surgery. Main outcome measures were rate of recurrent early vitreous hemorrhage, reoperation, intraocular pressure, visual acuity, and incidence of cataract formation. Mean follow-up time was 6 months. RESULTS: Rate of early rebleeding and reoperation were lower in patients taking intravitreal triamcinolone (P = 0.003 and 0.03, respectively). Visual acuity 6 months after operation was better in study group (P < 0.001). Mean intraocular pressure was higher 1 day and 1 week after procedure in study group compared with control group (P < 0.001 and 0.002, respectively); however, in other times its differences were not significant. No significant difference in rate of nuclear sclerosis and cortical cataract formation and other complication was noted between the two groups. However, there was a significantly increased rate of posterior subcapsular progression in a dose dependent manner in the study group versus control (P = 0.011). CONCLUSION: The present clinical study suggests that intravitreal injection of triamcinolone acetonide is effective in the prevention of rebleeding in eyes undergoing pars plana vitrectomy for treatment of diabetic vitreous hemorrhage.

The impact of macular laser photocoagulation on contrast sensitivity function in patients with clinically significant macular edema.

BACKGROUND: Contrast sensitivity is an important aspect of visual function and is even more important for ordinary daily tasks than visual acuity. Contrast sensitivity function may be deteriorated to a significant level in diabetic retinopathy, especially in diabetic macular edema. The objective of this study was to determine the impact of macular laser photocoagulation-as the standard treatment of clinically significant macular edema-on contrast sensitivity function. METHODS: In a prospective noncomparative interventional case series, 17 patients with clinically significant bilateral macular edema and no history of prior macular laser photocoagulation were enrolled. Baseline visual acuity, contrast sensitivity function, and fluorescein angiography were obtained and reassessed three months after macular laser photocoagulation. RESULTS: Clinically significant macular edema resolved in 22 (65%) of 34 eyes, three months after their first session of macular laser photocoagulation. The mean pretreatment visual acuity was 24.5/40 (0.21 logMAR) +/-10.3/40. Three months after macular photocoagulation, visual acuity remained stable in 19 eyes, decreased in 12 eyes, and increased in three eyes. The mean post-treatment visual acuity was 24/40 (0.24 logMAR) +/-10.8/40. There was a statistically significant (P = 0.02) decrease in visual acuity following laser therapy. In subgroup analysis, this decrease in visual acuity was only observed in those with unresolved clinically significant macular edema. The mean contrast sensitivity threshold increased in all spatial frequencies by three months after macular photocoagulation. The maximum rise was observed in the frequency of 6.4 cycles per degree in the mid range of frequencies, with a pretreatment mean of 9.41 dB and a post-treatment mean of 11.50 dB (P<0.05). CONCLUSION: Contrast sensitivity function improved after macular laser photocoagulation in clinically significant macular edema patients.

Hyperhomocysteinemia and central retinal vein occlusion in Iranian population.

PURPOSE: To evaluate total plasma homocysteine level during the acute phase of central retinal vein occlusion (CRVO) in the Iranian population and determine whether hyperhomocysteinemia is also a risk factor for CRVO. METHODS: Fifty-four patients with recently diagnosed CRVO were studied. Their fasting total plasma homocysteine level was compared with a matched control group of 51 patients evaluated in the same clinic for a non-retinal disease diagnosis. RESULTS: The mean total plasma homocysteine level was 14.76+/-7.67 micromol/l in cases, and 11.42+/-3.74 micromol/l in control subjects. It showed a significant difference (P=0.005) in mean plasma homocysteine level between cases and control group. Odds ratio of CRVO for individuals with hyperhomocysteinemia was 2.88 (95% CI=1.08-7.71 and P=0.03). The overall multivariable-adjusted odds of CRVO in participants with plasma homocysteine level above 15 micromol/l was 4.71 (95% CI=1.46-15.19 and P=0.009) Hyperhomocysteinemia was not statistically different in each age group (<60 years: 27%, 61-70 years: 33.3%, 71-80 years: 31.6%, >81 years: 33.3%, Chi-square test, P=0.98). CONCLUSION: Elevated total plasma homocysteine level is an independent risk factor for CRVO in Iranian population. In addition to an evaluation of all conventional cardiovascular risk factors, measurement of total homocysteine for evidence of hyperhomocysteinemia may be important in the initial investigation and management of patients with CRVO.

Multifocal electroretinogram in clinically significant diabetic macular edema.

OBJECTIVE: To explore the multifocal electroretinogram in patients with nonproliferative diabetic retinopathy with clinically-significant macular edema. METHODS: Forty-one eyes with clinically significant macular edema were tested. The latencies and amplitudes of average responses of 5 eccentric rings from 0 to 26 degrees relative to the fixation point were compared with normal values obtained from 13 nondiabetic subjects. RESULTS: Local electroretinogram responses were significantly delayed and decreased in amplitude in patients with clinically-significant macular edema. CONCLUSION: Multifocal electroretinogram can be used to quantify the visual function in clinically significant macular edema.