Early Macular Thickness Changes after Trabeculectomy and Combined Phaco-Trabeculectomy.

Purpose: To assess postoperative changes in central retinal thickness (RT) following trabeculectomy and combined phaco-trabeculectomy using spectral domain-optical coherence tomography. Methods: In a prospective interventional comparative study, 64 consecutive glaucoma patients who underwent trabeculectomy (32 eyes) or phaco-trabeculectomy (32 eyes) were included. A macular thickness map using the Early Treatment Diabetic Retinopathy Study circles of 1 mm, 3 mm, and 6 mm was the standard to evaluate the 9-subfield thickness preoperatively and again at 1 and 3 months after surgery. Four subfields in each of the 3 mm and 6 mm rings were considered parafoveal and perifoveal regions, respectively. Results: Preoperative measurements were similar in the two groups, except patients in the combined group which were older (P = 0.002). The mean RT in the combined phaco-trabeculectomy group at month 1 was significantly higher than baseline measurements at central subfield retinal thickness (CSRT) (P = 0.01), temporal (P = 0.001), and inferior (P = 0.04) parafoveal and temporal (P = 0.01), superior (P = 0.02), and nasal (P < 0.001) perifoveal quadrants; however, RT changes in the trabeculectomy-only group were not statistically significant at months 1 and 3 (P > 0.05). The increase in the temporal perifoveal RT of the combined phaco-trabeculectomy group persisted at month 3 (P = 0.01), while the RT in other sectors returned to preoperative values. The two treatment groups did not differ in terms of changes in the CSRT over time (P = 0.37). In addition, no difference was observed between the treatment groups regarding the parafoveal RTs at each time points (0.06 ≤ P ≤ 0.29). Conclusions: There was no significant difference in the pattern of changes of CSRT and parafoveal RT between trabeculectomy and combined phaco-trabeculectomy treatment groups up to 3 months after surgery. Some detectable increase in RT in the combined phaco-trabeculectomy will reverse to baseline values 3 months after surgery, except in the temporal perifoveal region.

Effect of trabeculectomy on optic nerve head and macular vessel density: an optical coherence tomography angiography study.

PURPOSE: To investigate the effect of trabeculectomy on peripapillary and macular vessel density (VD) using optical coherence tomography angiography (OCT-A) in patients with primary open-angle glaucoma. METHODS: This is a prospective, interventional study on 32 glaucoma eyes (21 patients) who underwent trabeculectomy. Optic nerve head (ONH) and macular structural and OCT-A scans were performed before surgery and at one and six months postoperatively with the Avanti device (AngioVue System, Optovue Inc., Fremont, CA). The primary outcomes of interest were changes in global and regional peripapillary and macular VD. RESULTS: The average (standard deviation) age and visual field mean deviation of the sample were 58.9(9.9) years and -14.5(9.0) dB, respectively. The average (standard deviation) baseline intraocular pressure significantly decreased from 24.5(10.4) mmHg to 9.6(2.1) mmHg, 6 months after the surgery (P< 0.001). The mean (standard deviation) whole image VD of ONH had increased from 37.6(8.3)% to 40.5(9.1)% at 6 months after the surgery (P = 0.01) while its changes were not significant at month 1 (38.1(9.5)%, P = 0.64). The average of radial peripapillary circle (RPC) VD increased from 36.5(10.3)% to 39.3(10.8)% at 6 months (P = 0.04) compared to 1-month post-trabeculectomy (37.0(11.4)%, P = 0.71). Similar patterns at postoperative months 1 and 6 were also observed in RPC VD at superior and inferior hemifields as well as nasal and temporal quadrants. The observed changes in VD of macular, foveal, peri-, and parafoveal were not significant at superficial or deep slabs at 1 and 6 months after trabeculectomy (all P values > 0.05). CONCLUSION: Our study demonstrated significant improvements in peripapillary vessel density at 6-month following trabeculectomy.

Spinal Intradural Extramedullary Dermoid Cyst.

BACKGROUND: Dermoid cysts are benign congenital tumors that develop early in life. These tumors are classified by the presence of all 3 germ layers. Spinal intradural extramedullary teratoma is a rare disease, which is more common in children under 5 years of age than in adults. CASE DESCRIPTION: A 12-year-old girl with a dermoid cyst at the lower lumbar level presented with 2-month low back pain and intermittent lower extremity radicular symptoms on the right side. Magnetic resonance imaging scan of the spine revealed an intradural extramedullary mass lesion at L4-5. Surgical excision of the cyst was successfully performed. Surgical and histopathologic findings confirmed extramedullary ruptured matured teratoma. Postoperatively, the patient had remarkable clinical improvement. CONCLUSIONS: Although dermoid cysts are uncommon, they should be considered in the differential diagnosis of spinal lesions in patients with lower back pain. It can be successfully treated with surgical excision.

Comparison of Effect of Lavandula officinalis and Venlafaxine in Treating Depression: A Double Blind Clinical Trial.

INTRODUCTION: Major depressive disorder is a chronic disease which may be associated with other mental illnesses. Lavandula officinalis and venlafaxine, herbal and chemical drugs respectively, are used to treat depression. Despite pharmacotherapy, major depressive disorder has a complicated pattern of resistance and recurrence. AIM: The aim of this study was to determine the effect of L. officinalis and venlafaxine in treating depression. MATERIALS AND METHODS: For this study, 120 patients referred to the psychiatry clinic of the Shahrekord University of Medical Sciences, Shahrekord, Iran, were randomly selected. The participants were randomly assigned to three groups: venlafaxine (Control Group), venlafaxine + L. officinalis (L. officinalis Group), and venlafaxine + placebo (Placebo Group). All the patients underwent treatment for six weeks. Depression test was administered to the three groups at different time intervals before the treatment, four weeks after the treatment and at completion of the treatment. The data were analysed by SPSS version17.0. RESULTS: Depression scores of all the groups decreased over time (p=0.001). The depression scores were significantly different between the control and L. officinalis groups (p=0.004), and the control and placebo groups (p=0.002), but were not significantly different between the L. officinalis and placebo groups (p=0.95). CONCLUSION: Adding L. officinalis or a placebo is equally effective in decreasing mean depression score and venlafaxine obviously decreased this score.