Advanced proliferative diabetic retinopathy in four young patients with flexion contractures (Rosenbloom syndrome).

In this report, we present four patients with type 1 diabetes of long duration (more than 20 years) who had multiple joint contractures (Rosenbloom syndrome) and who presented with reduced vision and advanced proliferative diabetic retinopathy. All of the cases had short stature which was non-familial and all had other microvascular complications (nephropathy and neuropathy). It seems that limited joint mobility (LJM) is a risk factor not only for microvascular complications, but also for more severe and advanced proliferative retinopathy.

Incidence and risk factors of retinopathy of prematurity in a tertiary eye hospital in Tehran.

AIM: To determine the incidence and risk factors of retinopathy of prematurity (ROP) in premature infants referred to a tertiary eye hospital during 2003-7 to provide preliminary evidence about ROP in Iran. METHODS: In a cross-sectional study, data for premature infants screened for ROP in Farabi Eye Hospital including possible risk factors and eye exams' results were recorded and analysed using chi(2), univariate and multiple regressions. Severe ROP was defined as ROP needing treatment or stage 4 or 5 of ROP. RESULTS: Among 953 premature infants, there were 329 (34.5%) different stages of ROP. Severe ROP was seen in 22.6% (215/953) of infants (16.5%: treatable, 6.1%: advanced untreatable). The mean gestational age (GA) and birth weight (BW) of infants with severe ROP were 28.8 (SD 2.4) weeks and 1256 (389) g respectively. Univariate analysis showed a significant relation between GA, BW, oxygen therapy, blood transfusion and ROP (p<0.001), while multiple-regression methods showed GA, BW and oxygen therapy as independent predictors of ROP (p<0.001, 0.019 and 0.033, respectively). CONCLUSION: The authors observed a relatively high incidence of ROP in this series, especially its severe form affecting relatively more mature infants, which merits further investigation. GA, BW and oxygen therapy were independent ROP determinants.

Single-session photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration.

PURPOSE: To evaluate the efficacy of combined single-session photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) for treatment of neovascular age-related macular degeneration (AMD). METHODS: In a prospective interventional case series, patients with subfoveal choroidal neovascularization (CNV) underwent PDT followed by 1.25 mg IVB injection. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) measurements were repeated at 6-week intervals and fluorescein angiography was performed after 12 weeks and when considered necessary thereafter. Repeat injections of IVB were performed based on fluorescein angiographic evidence of CNV leakage. RESULTS: Fourteen eyes were included in this study. Mean follow-up was 52.4+/-15.2 weeks (range: 26-74 weeks). Initially, mean BCVA was 0.80+/-0.42 logMAR and mean central macular thickness (CMT) was 308+/88 microm. At week 12, BCVA improved to 0.62+/-0.47 logMAR (p=0.006) and CMT reduced to 186+/-53 microm (p=0.003). Corresponding results were 0.53+/-0.52 logMAR (p=0.02) and 193+/-78 microm (p=0.002) after 24 weeks. A second IVB injection was performed in 13 eyes with a mean interval of 16.3+/-5.9 weeks. CONCLUSIONS: Combination therapy with single-session PDT and IVB can improve vision and reduce CMT in neovascular AMD. Repeat IVB injections may maintain the visual gain from the initial combination therapy.

Visual function after implantation of aniridia intraocular lens for traumatic aniridia in vitrectomized eye.

PURPOSE: To evaluate the efficacy and safety of aniridia posterior chamber intraocular lens (PCIOL) in traumatic aniridia and aphakia in vitrectomized eyes. METHODS: Four aphakic patients with traumatic aniridia and previous pars plana vitrectomy (PPV) due to posterior segment trauma enrolled in the study, and had secondary implantation of an aniridia PCIOL. Two patients were men and two women with mean age of 39.25 years. Complete ophthalmic examinations, including preoperative and postoperative visual acuity in dark and light, glare disability, visual function (using VF-9 questions modified from VF-14), stereopsis, and contrast sensitivity in 3, 6, 12, and 18 cycle per degree frequencies, were done for all patients. Postoperative intraocular pressure (IOP), IOL centration, and intraocular inflammation were monitored. Mean follow-up was 12.25 months (range 7 to 15 months). RESULTS: Visual acuity improved in all four patients, especially in the light. Glare was subjectively reduced in all of them. Stereopsis was measurable in three of them postoperatively. Contrast sensitivity improved in all patients, especially in brightness and lower frequencies. All four eyes had improved VF-9. All eyes achieved the desired anatomic results. Two cases developed elevated IOP early after surgery. In one eye, IOP elevation was transient and controlled with antiglaucoma medication, but the other eye, which had secondary glaucoma from previous trauma, required cyclophotocoagulation for the IOP to be controlled. No patient developed chronic uveitis or redetachment. CONCLUSIONS: The aniridia PCIOL can overcome aphakia, reduce glare, and increase visual function, contrast sensitivity, and stereopsis in vitrectomized eyes with traumatic aniridia. Although this kind of IOL appears safe, some disadvantages are secondary glaucoma and reduced visibility of peripheral fundus, and caution should be used in its implantation until more patients with longer follow-up are studied.