Multimodal imaging in posterior microphthalmos.

PURPOSE: To evaluate the multimodal imaging including optical coherence tomography angiography (OCTA) findings in patients with posterior microphthalmos (PM). METHODS: In an observational case series, four eyes of two patients, eight and twenty-three years old, with clinical proven PM underwent complete ophthalmic examination, including refraction, fluorescein angiography, optical coherence tomography (OCT), OCTA, B-scan ultrasonography, axial length measurement using IOL Master optical measuring, and Pentacam evaluation. RESULTS: Both patients were high hyperopic with partial thickness retinal fold in macula, retinoschisis, and foveal hypoplasia. Axial length was less than 17 mm with scleral thickening in all eyes. OCTA showed absence of foveal avascular zone (FAZ) in both superficial and deep capillary plexuses. Pentacam showed corneal steepness, shallow anterior chamber, and low anterior chamber volume. CONCLUSION: OCTA findings showed absence of avascular zone in both superficial and deep capillary plexuses, while OCT shows partial thickness retinal fold and retinoschisis.

Dermatoscopic and Mucoscopic Features of Lesions in Patients with Behcet's Disease.

OBJECTIVE: Behcet's disease (BD), as a vasculitis, can affect small and large vessels. As dermatoscopy has been shown to improve the accuracy in diagnosis of various skin lesions especially vascular patterns, we set this study to find if there is any characteristic pattern in the dermatoscopy of Behcet's mucocutaneous lesions. METHODS: This prospective cross-sectional observational study designed to evaluate dermatoscopic features of Behcet's mucocutaneous lesions. Fifty six consecutive patients presenting at the outpatient clinic of the BD Research Unit were included. If present, for each patient one oral, one skin and one genital lesion were evaluated by dermatoscopy. When indicated, pathergy test was performed according to a standard protocol and the results were evaluated by dermatoscopy. RESULTS: A total of 40 oral, 8 genital, 14 skin lesions and 14 pathergy tests were evaluated by dermatoscopy. While vascular component was the most prominent feature in oral aphthae, this component was less prominent in genital lesions. Dot vessels were the most common form of vessels in both oral and skin lesions. All the oral lesions were characterized by a central white structureless area. Skin lesions were characterized by a red structureless background. In pathergy tests, negative pricks showed absence of specific features while positive pricks were characterized by a structureless background in pink, purple or red. No obvious vascular component was detected in any of the pricks. CONCLUSION: It seems that these findings have no specific clues for the diagnosis of BD, but our study is the first study in this field and the findings may give way to further investigations.

Refractive surgery: the most cost-saving technique in refractive errors correction.

AIM: To compare the lifetime and annual economic burden of spectacles, contact lenses, and refractive surgery in correction of refractive errors. METHODS: This is a cross-sectional study with convenience sampling which 120 patients were interviewed in a tertiary referral hospital in the Iranian health care system. The bottom-up based cost of illness approach was estimated using a face-to-face interview to assess the direct and indirect cost of different refractive errors correction of any correction technologies. RESULTS: Correction with spectacle imposes a total direct cost of US dollar (US$) 342.5 (±8.41) per year and US$9373.5 (±230.1) per lifetime to each patient. These figures for the contact lenses were obtained US$198.3 (±0.12) and US$5203.1 (±256.3) and for refractive surgery were obtained US$19.1 (±1.2) and US$568.1 (±64.6), respectively. Overall, based on age-adjusted prevalence rates, astigmatism had the highest share of refractive errors economic burden with a lifetime direct cost of slightly less than US$5.49 billion, while hyperopia and myopia imposed less than US$5.24 and 4.2 billion on patients, respectively. The annually imposed cost on each individual Iranian patient with refractive errors is US$308.5. CONCLUSION: Based on 18mo post refractive surgery course observation, which is generalized to whole life, refractive surgery significantly imposed much less cost compared with spectacles and contact lenses. Refractive errors among Iranians result in considerable economic burden. Using the refractive surgery instead of other two correction methods has the ability to reduce this economic loss in the future.

Characteristics of Macular Edema in Behcet Disease after Intravitreal Bevacizumab Injection.

PURPOSE: To investigate the effect of intravitreal bevacizumab (IVB) injection on macular edema (ME) secondary to Behcet's disease. METHODS: This prospective case series included 15 patients with bilateral ME due to Behcet's disease. Intravitreal bevacizumab was injected into the more severely involved eye; the contralateral eye was evaluated as the control. Patients were followed up with comprehensive ocular examination, optical coherence tomography, and fluorescein angiography (FA) for a minimum of 6 months by a single ophthalmologist. RESULTS: Patients with a mean age of 30.6 ± 7.4 years received a mean number of 3.3 IVB injections during the 6 months. The mean preinjection vision was 0.6 ± 0.3 and 0.4 ± 0.4 LogMAR in the case and control groups, respectively, with no significant improvement at 6 months. Mean central foveal thickness was 375.3 ± 132.1 and 307.2 ± 84.5 µm in the case and control groups, respectively, and these changed to 401 ± 199.9 (P = 0.65) and 307.7 ± 82.8 µm (P = 0.73) at month 6, respectively. A statistically nonsignificant improvement in ME was observed during the first 3 months in the case group. However, it did not persist up to month 6 on an as-needed basis. IVB injections caused a disproportionate decrease in the thickness of macular subfields. A reduction in disc leakage was observed on FA (P = 0.058). Logistic regression analysis revealed no statistically significant predictive factor for an improvement in visual acuity (VA) and a reduction in foveal thickness. CONCLUSION: During a 6-month period, IVB injections based on an as-needed protocol provided no statistically significant improvement in VA and ME.

Ophthalmic findings in Behcet׳s disease: Cases without apparent ocular signs.

PURPOSE: To evaluate the fluorescein angiography and infrared autofluorescence finding in patients with confirmed Behcet׳s disease (BD) but without clinical ocular signs. METHODS: In this prospective, non-interventional case series, montage fluorescein angiography (MFA) and infrared autofluorescence imaging were performed for all patients with confirmed BD but without ocular signs in clinical examination. RESULTS: Fifty BD patients (100 eyes) without clinical ocular manifestations were investigated. In MFA, we found fluorescein angiography (FA) leakage in 22 cases (44%) in both eyes, mostly at the periphery of retina. In infrared autofluorescence, profound changes were found in 43 patients, 86 eyes (86%). Twenty-five patients, 50 eyes (50%), presented retinal vascular branching modifications, straightening, tortuosity, and shunt. CONCLUSION: MFA of retina may be useful in patients with presumed BD for early diagnosis, early treatment, and follow-up of patients.

Characteristics of Germline and Non-germline Retinoblastomas.

PURPOSE: To discuss the clinical characteristics, treatment and outcomes of germline and non-germline retinoblastoma tumors. METHODS: A retrospective study was performed on retinoblastoma cases from 1979 to 2007. General characteristics of the patients, treatment modalities, histopathological findings and survival were compared in germline versus non-germline cases. RESULTS: We analyzed 557 cases of retinoblastoma with mean age of 32.2±22.0 months including 177 and 380 patients with germline and non-germline tumors, respectively. Germline cases were significantly different from non-germline counterparts in terms of mean age (24.7±17.7 vs 35.7±23.0 months), symptoms (leukocoria in 49.4% vs 62.9%), and outcomes (death in 40.1% vs 13.9%), respectively (P<0.001). In the germline group 66.5% and in non-germline group over 97% of patients had stage Va or higher (ICRB D-E disease). Disease-free survival was 48.6% for germlines cases versus 80.9% for non-germline patients (with mean follow up of 61.9 months, P<0.001). Histopathologically, more invasions to intraocular and extraocular tissues were seen with non-germline tumors of (66% vs 39.8%). Mortality rates in germline cases and non-germline were 40.1% and 13.9%, respectively (P<0.001). CONCLUSION: Despite higher tumor staging in nongermline cases at the time of diagnosis and therefore more aggressive behavior of the tumor, germline cases had a higher rate of mortality during the follow up period.

Intravitreal bevacizumab (Avastin) for the treatment of cystoid macular edema in Behçet disease.

PURPOSE: To investigate the effect of bevacizumab on cystoid macular edema in Behçet disease. METHODS: Twelve eyes of 11 patients with Behçet disease underwent optical coherence tomography, fluorescein angiography, and visual acuity measurement before and after the intravitreal injection of Avastin to evaluate its effect. RESULTS: The visual acuity improved in 7 eyes. Foveal thickness and macular volume did not show statistically significant differences. Fluorescein angiography reduced in grading in 4 patients and was deteriorated in 2. CONCLUSIONS: The intravitreal injection of Avastin could be effective in the improvement of the vision in patients with uveitis secondary to Behçet disease.

Ocular features of Behcet's disease: an international collaborative study.

OBJECTIVE: To investigate the clinical features of ocular lesions in Behçet's disease in different countries. METHODS: A descriptive questionnaire survey was performed. RESULTS: 25 eye centres in 14 countries returned questionnaires on prevalent cases in 2006. Clinical data were analysed on 1,465 patients with ocular lesions. Recurrent oral aphthous ulcers were reported in 94.5%, skin lesions in 69.5% and genital ulcers in 61.4%. Most of the patients had bilateral and recurrent intraocular inflammation. Poor visual acuity was seen in 18.9% in women, but 24.8% in men (p<0.01). Panuveitis was seen more in men than in women (p<0.01). 23% of the patients had visual acuity equal to or worse than 20/200 at the final visit. The patients with poor vision were more frequently in India, Iran and Japan than in other countries (p<0.01). CONCLUSIONS: We report the largest contemporary international case series of patients with ocular involvement in Behçet's disease. Panuveitis was significantly more frequent in men than women, and men tended to have a worse visual prognosis. There were some differences in the clinical pattern of Behçet's disease in different countries. Despite modern treatment, the disease still carries a poor visual prognosis with one-quarter of the patients blind.

Long-term surgical outcome of posterior choroidal melanoma treated by endoresection.

PURPOSE: To report the visual acuity, enucleation rates, and initial mortality after transvitreal endoresection of posterior uveal melanoma. METHODS: Twenty consecutive patients with medium-sized posterior choroidal melanomas were treated. Vitrectomy was performed, followed by posterior hyaloid dissection, retinotomy, melanoma removal with a vitrectomy probe, retinal reattachment with perfluorocarbon liquid, and silicone oil or gas exchange. RESULTS: Twenty patients (13 men [65%] and 7 women [35%]) were included in the study. The mean patient age +/- SD was 47.1 +/- 16 years (range, 22-70 years). Tumor thickness and tumor diameter ranged from 5.5 mm to 11 mm and 8.0 mm to 15.7 mm, respectively. Preoperative visual acuity ranged from hand motion to 20/40, and postoperative visual acuity ranged from no light perception to 20/30. Two eyes (10%) were enucleated during tumor resection due to severe bleeding. Enucleation was performed on 3 eyes (15%) during follow-up due to tumor recurrence at the edge of surgical coloboma in 1 patient, new focus of tumor in another sector distant from surgical coloboma in 1 patient, and painful blind eye in 1 patient. Fifteen eyes (75%) were saved. One patient (5%) died of metastasis to the liver. The mean follow-up period +/- SD was 89.55 +/- 38.4 months (range, 24-132 months. CONCLUSION: These data suggest that transvitreal endoresection of posterior uveal melanoma is an acceptable management option to conserve the globe and functional vision in selected patients. Distant metastasis is an infrequent event in this modality of treatment.

Frequency and assortment of self-report occupational complaints among Iranian ophthalmologists: a preliminary survey.

BACKGROUND: Ophthalmology is unique in that its practitioners are exposed to a host of ergonomic (eg, indirect ophthalmoscopy), ergo-ophthalmologic (laser), infectious (adenovirus), and allergic (topical anesthetics) hazards. The purpose of this study is to provide a preliminary occupational health profile of Iranian ophthalmologists. METHODS: A comprehensive list of occupation-related entities was incorporated into a questionnaire, which was distributed among 350 ophthalmologist participants of the Annual Iranian Congress of Ophthalmology (November 2000, Tehran) and was mailed twice to the 1050 nation's registered ophthalmologists. Independent Samples t and chi-square tests were used to assess the relationships. RESULTS: One hundred sixty-two questionnaires were returned. The mean career time was 15.7 (range, 1-40) years. Twenty (12.3%) of the participants were women. The reported prevalences were as follows: history of infectious conjunctivitis, 49.4%; contact dermatitis, 43.2%; back pain, 80%; chronic headache, 54.9%; and laser or operating microscope-related visual disturbances, 15%. Psychological indispositions were reported by two thirds. Age and career time were inversely related to contact dermatitis, chronic headache, and stress-related problems (P < .05). Visual complaints were more prevalent in vitreoretina surgeons (P < .004). Psychosocial disorders were significantly more reported by women (P = .026; odds ratio = 4.4). Only 3% of participants reported to have none of the listed problems. CONCLUSION: Our preliminary survey disclosed a high prevalence of diverse complaints from back and neck pain, contact dermatitis, visual disturbances, and infectious conjunctivitis to stress-related and psychosocial disorders among the participants. Younger age, being a woman, and vitreoretina practice were the complaints correlates. Due to the low response rate, uncertainty over the representativeness and coverage of the sample, and lack of control groups, the findings have to be interpreted conservatively.