Erythropoietin in ophthalmology: A literature review

Purpose: To review the current literature on ocular application of erythropoietin (EPO). Methods: A comprehensive search was performed on Pubmed and Scopus databases. All selected articles were reviewed thoroughly by the authors to review current applications of the EPO in ocular diseases. Results: Various aspects of administration of EPO for different ischemic, traumatic, vascular, and degenerative disorders have been explained. The articles are generally preclinical with few small studies reporting clinical outcomes. Conclusion: EPO has been used for the treatment of different ophthalmic conditions with promising results. Further studies are needed to elaborate the role of EPO in management of ocular diseases. © 2016 Iranian Society of Ophthalmology

Comparison of the effect of cycloplegic versus NSAID eye drops on pain after photorefractive keratectomy

Purpose: To compare the effect of Homatropine and Diclofenac eye drops for reducing pain after photorefractive keratectomy (PRK). Methods: This randomized, double-masked, interventional study included 32 patients (64 eyes) who underwent bilateral PRK. After operation, patients received Homatropine eye drops in one eye and Diclofenac eye drops in the fellow eye for 48 h. The level of pain was evaluated using visual analogue scale (VAS), verbal rating scale (VRS), and pain rating index (PRI) at 0.5, 24, and 48 h after operation. Results: The level of pain was statistically similar between the two eyes half an hour after operation; however, Diclofenac eyes had significantly less pain 24 h after operation (1.7 ± 1.4 vs 5.8 ± 2.1, P < 0.001 for VAS, 0.6 ± 0.6 vs 2.4 ± 1.1, P < 0.001 for VRS, and 3.4 ± 3.4 vs 12.0 ± 6.9, P < 0.001 for PRI, respectively). Also, 48 h after surgery, the pain scores were less in the Diclofenac eyes (1.6 ± 1.8 vs 3.4 ± 2.8, P < 0.001 for VAS, 0.6 ± 0.6 vs 1.2 ± 0.9, P < 0.001 for VRS, and 3.3 ± 3.7 vs 6.5 ± 6.2, P < 0.001 for PRI). No case with delayed epithelial healing in both groups was observed. Conclusion: The effect of Homatropine seems to be lower compared to Diclofenac for reducing pain after photorefractive keratectomy. © 2015 Iranian Society of Ophthalmology

Endophthalmitis caused by Acinetobacter spp. as the presenting manifestation of diabetes mellitus

Purpose We describe a patient with endogenous endophthalmitis caused by Acinetobacter spp. as the first clinical presentation of diabetes mellitus. Method A 48-year-old otherwise healthy woman was referred with signs and symptoms of acute endophthalmitis in the left eye. Systemic work-up, vitreous tap, and intravitreal antibiotic injection were performed followed by pars plana vitrectomy. Results The laboratory tests confirmed the diagnosis of diabetes mellitus. Vitreous culture was positive for Acinetobacter spp., and the organism was sensitive to colistin. One month after surgery, vision was no light perception, and the eye was phthisical. Conclusion Diagnostic work-up should be performed even in otherwise healthy patients with endogenous endophthalmitis. © 2016 Iranian Society of Ophthalmolog

Superior ophthalmic vein thrombosis following coil embolization of posterior communicating artery aneurysm: Report of two cases

Introduction: The purpose was to present two patients with superior ophthalmic vein thrombosis following coil embolization of posterior communicating artery aneurysm, that have not been reported after this particular procedure yet. Methods: We present two patients with subarachnoid hemorrhage due to posterior communicating artery aneurysms, who were treated with stent-assisted coil embolization. Shortly after the procedure, both cases demonstrated painful proptosis, ophthalmoplegia, increased intraocular pressure, intraretinal hemorrhage and macular edema on the ipsilateral side, with congestion of intraorbital tissues and thickened and dilated superior ophthalmic vein in neuroimaging investigation. The occlusion was confirmed by digital subtraction angiography. Results: Patients were treated with anticoagulant agents and systemic corticosteroids immediately and then received medical treatment by an ophthalmologist for ocular complications of superior ophthalmic vein thrombosis. Conclusion: Isolated superior ophthalmic vein thrombosis (SOVT) is rare, but may be associated with sight-threatening complications. After intracranial interventions on cerebral vessels, clinical features of SOVT including choroidal effusion syndrome should be investigated, and the patients should receive prompt and proper care including ophthalmic medications and systemic anticoagulants to restrict the ocular and systemic complications. © The Author(s) 2020

Refractive outcomes following the treatment of retinopathy of prematurity in the anti-VEGF era: a literature review

A growing body of evidence indicates that antivascular endothelial growth factor (VEGF) therapy is effective in the treatment of retinopathy of prematurity (ROP). We conducted a comprehensive literature review on refractive outcomes of anti-VEGF treatments compared to laser treatment or a combination of laser therapy and anti-VEGF injections. Of the 9 studies analyzed, the final mean refractive error was myopic in 3 studies (37) with IVB monotherapy, 7 studies (87.5) with laser photocoagulation, and 1 study (50) with combined therapy. In comparing IVB with laser monotherapy, 6 of 7 studies (86) reported that final refractive error was significantly more myopic (>1 D) after laser treatment. No study was graded as high quality, and only a single article provided moderate quality of evidence. © 2016 American Association for Pediatric Ophthalmology and Strabismu

Superior ophthalmic vein thrombosis following coil embolization of posterior communicating artery aneurysm: Report of two cases

Introduction: The purpose was to present two patients with superior ophthalmic vein thrombosis following coil embolization of posterior communicating artery aneurysm, that have not been reported after this particular procedure yet. Methods: We present two patients with subarachnoid hemorrhage due to posterior communicating artery aneurysms, who were treated with stent-assisted coil embolization. Shortly after the procedure, both cases demonstrated painful proptosis, ophthalmoplegia, increased intraocular pressure, intraretinal hemorrhage and macular edema on the ipsilateral side, with congestion of intraorbital tissues and thickened and dilated superior ophthalmic vein in neuroimaging investigation. The occlusion was confirmed by digital subtraction angiography. Results: Patients were treated with anticoagulant agents and systemic corticosteroids immediately and then received medical treatment by an ophthalmologist for ocular complications of superior ophthalmic vein thrombosis. Conclusion: Isolated superior ophthalmic vein thrombosis (SOVT) is rare, but may be associated with sight-threatening complications. After intracranial interventions on cerebral vessels, clinical features of SOVT including choroidal effusion syndrome should be investigated, and the patients should receive prompt and proper care including ophthalmic medications and systemic anticoagulants to restrict the ocular and systemic complications. © The Author(s) 2020

Necrosis of the optic nerve and chiasm with safe radiation doses: Report of two rare cases

Introduction: Radiation-induced optic neuropathy (RION) is still a devastating complication of brain and skull base radiation that has no effective treatment up until today, thus uttermost caution must be taken in treating patients that brain radiotherapy is needed. We present two cases of RION that happened in seemingly safe radiation doses. Case description: A 48-year-old female with a history of pleomorphic pituitary adenoma developed bilateral and painless loss of vision 10 months after radiation to the brain; the total radiation dose was 45 Gy in 25 fractions and no other risk factors of RION were found. Magnetic resonance imaging of the brain depicted bilateral prechiasmatic optic nerve enhancement with involvement of the optic chiasm. Treatment with high doses of corticosteroids was unsuccessful. A 62-year-old female with a history of lung adenocarcinoma and brain metastases presented with a 1-month history of decreased vision in both eyes. He had undergone whole-brain radiotherapy with a total dose of 30 Gy over 10 fractions and concurrent chemotherapy with cisplatin and pemetrexed. Brain magnetic resonance imaging (MRI) with contrast showed bilateral intracranial optic nerve enhancement. Conclusions: This is the second case report of RION in a patient with a history of brain radiotherapy and concurrent chemotherapy with pemetrexed. History of chiasmal compression, concurrent use of chemotherapeutic agents, and high fraction size (despite the safety of total radiation dose) were possible contributing risk factors to develop RION in our cases. Hence, adjusting the radiation dose according to the presence of these risk factors is recommended. © The Author(s) 2021

Anti-VEGF treatment and peripheral retinal nonperfusion in patients with central retinal vein occlusion

Kaveh Abri Aghdam,1,* Lukas Reznicek,2,* Mostafa Soltan Sanjari,1 Annemarie Klingenstein,2 Marcus Kernt,2 Florian Seidensticker2 1Department of Ophthalmology, Eye&nbsp;Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran; 2Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany *These authors contributed equally to this work Purpose: To evaluate the association between the size of peripheral retinal nonperfusion and the number of intravitreal ranibizumab injections in patients with treatment-na&iuml;ve central retinal vein occlusion (CRVO).Methods: Fifty-four patients with treatment-na&iuml;ve CRVO and macular edema were included. Each patient underwent a full ophthalmologic examination including optical coherence tomography imaging and ultrawide-field fluorescein angiography. Monthly intravitreal ranibizumab injections were applied according to the recommendations of the German Ophthalmologic Society. Two ophthalmologists quantified the areas of peripheral retinal nonperfusion (group 1= less than five disc areas, group 2= more than five disc areas). Correlation analyses between the size of nonperfusion with best-corrected visual acuity, central subfield thickness, and the number of intravitreal injections were performed.Results: Best-corrected visual acuity improved significantly after intravitreal injections (P&lt;0.001, both groups). Final central subfield thickness after treatment did not significantly differ between both groups (P=0.92, P=0.96, respectively). Mean number of injections in group 1 and group 2 was 4.12&plusmn;2.73 and 9.32&plusmn;3.84, respectively (P&lt;0.001). There was a significant positive correlation between areas of nonperfusion and the number of injections in each group. (R=0.97, P&lt;0.001; R=0.94, P&lt;0.001, respectively).Conclusion: Peripheral retinal nonperfusion in patients with CRVO correlates significantly with the number of needed intravitreal ranibizumab injections. Ultrawide-field fluorescein angiography is a useful tool for detection of peripheral retinal ischemia, which may have direct implications in the diagnosis, follow-up, and treatment of these patients. Keywords: angiography, central retinal vein occlusion, non-perfusion, retina, wide-fiel

A novel decision tree approach to predict the probability of conversion to multiple sclerosis in Iranian patients with optic neuritis

Background: assessing the risk of conversion to multiple sclerosis (MS) in patients with optic neuritis (ON) has been the topic of numerous studies. However, since the risk factors differ from population to population, the extension of conclusions is a matter of debate. This study focused on the Iranian patients with optic neuritis and assessed the probability of conversion to multiple sclerosis by using a machine-based learning decision tree. Methods: in this retrospective, observational study the medical records of patients with optic neuritis from 2008 to 2018 were reviewed. Baseline vision, the treatment modality, magnetic resonance imaging (MRI) findings, and patients� demographics were gathered to evaluate the odds of each factor for conversion to MS. The decision tree was then obtained from these data based on their specificity and sensitivity to predict the probability of conversion to MS. Results: the overall conversion rate to MS was 42.2 (117/277). 63.1 percent of patients had abnormal MRIs at baseline. The presence of white matter plaque had the highest odds for the conversion followed by the positive history of optic neuritis attack and gender. The regression tree showed that the presence of plaque was the most important predicting factor that increased the probability of conversion from 16 to 51 percent. Conclusion: the decision tree could predict the probability of conversion to MS by considering multiple risk factors with acceptable precision. © 202