Surgical management of glaucoma in Fuchs uveitis syndrome: Trabeculectomy or Ahmed glaucoma valve

Purpose: To evaluate the outcome of trabeculectomy versus Ahmed glaucoma valve (AGV) surgery in patients with Fuchs uveitis Syndrome (FUS). Methods: Twenty-eight eyes with uncontrolled glaucoma and at least 6 months of follow-up were enrolled. In 16 eyes trabeculectomy and in 12 eyes AGV implant were performed. The primary outcome measure was surgical success defined as 5 < intraocular pressure (IOP) � 21 mmHg (criterion A) and 5 < IOP � 16 mmHg (criterion B), with at least 20 reduction in IOP, either with no medication (complete success) or with no more than preoperative medications (qualified success). The sum of complete and qualified success was defined as cumulative success. Results: The mean age of the patients in the trabeculectomy group and the AGV group was 44.92 ± 9.02 and 45.76 ± 7.10 years, respectively (P = 0.79). The mean duration of follow-up was 23.06 ± 12.03 months in the trabeculectomy group and 22.83 ± 13.63 months in the AGV group (P = 0.96). The baseline mean IOP in trabeculectomy was 26.81 ± 6.69 mmHg which decreased to 11.61 ± 4.15 mmHg at last visit (P < 0.001). In the AGV group, mean IOP was 31.41 ± 6.76 at baseline that changed to 22.41 ± 5.09 at last visit (P = 0.005). According to criterion A, cumulative success rates were 100 and 91 at 6 months and 76 and 9 at 36 months in the trabeculectomy and the AGV group, respectively. Cumulative success rates at 6 months were 93 and 58 and 65 and 7 at 36 months according to criterion B in the trabeculectomy and the AGV group, respectively. Kaplan-Meier survival analysis revealed a significant association between surgical method and cumulative success rate over 36 months (based on criteria A: P = 0.02, and based on criteria B: P = 0.007). Conclusion: The success rate of trabeculectomy was higher than AGV in the surgical management of glaucoma in FUS during a medium-term follow-up. © 2018 Iranian Society of Ophthalmolog

Half-dose photodynamic therapy for chronic central serous chorioretinopathy

Purpose: To report the outcomes of half-dose photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (CSC). Methods: A chart review of patients with chronic CSC who had received half-dose verteporfin PDT (3 mg/m2) was performed. The main outcome measures were resolution of subretinal fluid and best corrected visual acuity (BCVA). Results: Fifty-three eyes of 51 patients with mean age of 45.01 ± 8.9 years were studied. Three, 6 and 12 months after half-dose PDT, subretinal fluid was completely resolved in 51 eyes (96.2). In 2 eyes (one patient), subretinal fluid decreased at 3 months but one year later, an increase in subretinal fluid was detected on optical coherence tomography (OCT) which completely resolved following additional PDT. Another patient with recurrence of subretinal fluid rejected further treatment. Mean baseline central subfield thickness was 385 ± 113.0 μm which was decreased to 235 ± 39.7, 247 ± 49.7, and 244 ± 49.52 μm after 3, 6 and 12 months, respectively (all P-values &lt; 0.001). Mean BCVA was 0.33 ± 0.27 LogMAR before PDT and 0.11 ± 0.18, 0.11 ± 0.17, 0.17 ± 0.26 and 0.10 ± 0.23 LogMAR, 3, 6 and 12 months and at final visit (up to 60 months) after PDT, respectively (all P-values &lt; 0.001). Improvement �2 lines in BCVA occurred in 20 eyes (37.7). Statistically significant correlations were found between improvement in BCVA and baseline BCVA, baseline central subfield thickness and central subfield thickness after resorption of subretinal fluid (P &lt; 0.001, P= 0.04 and P= 0.01, respectively). No complications attributed to PDT were observed. Conclusion: Half-dose PDT is effective for treatment of patients with chronic CSC. © 2016 Journal of Ophthalmic and Vision Research

Scleral buckling surgery for rhegmatogenous retinal detachment with subretinal proliferation

PurposeTo evaluate the outcome of scleral buckling surgery in patients with rhegmatogenous retinal detachment (RRD) with subretinal proliferation.MethodsIn this retrospective study, a chart review of all patients with RRD associated with subretinal proliferation who were primarily treated with scleral buckling procedure, from April 2007 to April 2014, was undertaken. Main outcome measures were anatomical retinal reattachment and visual acuity.ResultsForty-four eyes of 43 patients including 24 males and 19 females with a mean age of 26.5±13.1 years were evaluated. Immediately after the surgery, retina was reattached in all eyes. However, five eyes (11.3) needed additional surgery for retinal redetachment. Single surgery anatomical success rate was 88.7. Four eyes (9.1), needed pars plana vitrectomy for the treatment of redetachment associated with proliferative vitreoretinopathy and scleral buckle revision surgery was successfully performed in the other eye. Best corrected visual acuity improved from 1.5±0.9 logMAR before surgery to 1.1±0.7 logMAR after surgery (P2 lines was found in 23 eyes (52.2) and worsening of best corrected visual acuity of >2 lines was observed in 2 eyes (4.5).ConclusionsScleral buckling surgery is highly successful in eyes with RRD associated with subretinal proliferation. © 2015 Macmillan Publishers Limited All rights reserved

Effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve implantation: A randomized control trial

Importance: The effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve (AGV) implantation. Background: Evaluation of efficacy and safety of subconjunctival Bevacizumab injection adjunctive to AGV implantation. Design: Prospective and randomized clinical trial. Participants: Fifty eyes of 50 patients with diagnosis of glaucoma that were candidate for AGV surgery were included. Methods: In 25 eyes, conventional AGV surgery (group 1) and in 25 eyes AGV surgery with subconjunctival Bevacizumab (group 2) was performed by block randomization Main Outcome Measures: The primary outcome measure was surgical success. Outcome measures were compared at postoperative month 3, 6 and 12. Results: Mean age of patients was 58.76 ± 12.11 and 51.36 ± 15.44 years in group 1 and 2 respectively (P = 0.06). Mean intraocular pressure (IOP) at baseline was 24.88± 7.62mmHg in group 1 and 27.52± 8.57mmHg in group 2 which decreased to15.4 ± 4.4 mmHg in group 1 and 13.42± 2.9 mmHg in group 2 (P < 0.00) at last follow up. Surgical success was defined in two level: postoperative IOP �21mmHg with at least 20 reduction in IOP (Criterion A), either with no medication (complete success) or with no more than two medications (qualified success) and criterion B with the same definition but the IOP �18mmHg The cumulative success according to criterion A and B was 77.8, 72.2 in group 1 and 89.5 in group 2, respectively, at the end of follow-up. Conclusions and Relevance: Subconjunctival injection of Bevacizumab adjunctive to AGV implantation leads to higher success rate compared with AGV alone in one year follow-up. © 2018 Royal Australian and New Zealand College of Ophthalmologists

Temporal Artery Biopsy for Diagnosing Giant Cell Arteritis: A Ten-year Review

Purpose: To assess the use of temporal artery biopsy (TAB) in diagnosing giant cell arteritis (GCA) and to evaluate patients� clinical and laboratory characteristics. Methods: We conducted a retrospective chart review of patients with suspected GCA who underwent TAB and had complete workup in a tertiary center in Iran between 2008 and 2017. The 2016 American College of Rheumatology (ACR) revised criteria for early diagnosis of GCA were used for each patient for inclusion in this study. Results: The mean age of the 114 patients in this study was 65.54 ± 10.17 years. The mean overall score according to the 2016 ACR revised criteria was 4.17 ± 1.39, with 5.82 ± 1.28 for positive biopsies and 3.88 ± 1.19 for negative biopsies (p <0.001). Seventeen patients (14.9) had a positive biopsy. Although the mean post-fixation specimen length in the biopsy-positive group (18.35 ± 6.9 mm) was longer than that in the biopsy-negative group (15.62 ± 8.4 mm), the difference was not statistically significant (P = 0.21). There was no statistically significant difference between the groups in terms of sex, serum hemoglobin, platelet count, and erythrocyte sedimentation rate. There were statistically significant differences between the biopsy-negative and biopsy-positive groups with respect to patients� age and C-reactive protein level (P < 001 and P = 0.012, respectively). Conclusion: The majority of TABs were negative. Reducing the number of redundant biopsies is necessary to decrease workload and use of medical services. We suggest that the diagnosis of GCA should be dependent on clinical suspicion. © 2020 JOURNAL OF OPHTHALMIC AND VISION RESEARC

Ocular higher-order aberrations changes after implantable collamer lens implantation for high myopic astigmatism

Purpose: To investigate the changes in higher-order aberrations (HOAs) induced by the implantation of implantable collamer lenses (ICLs) and Toric ICL (TICL) in eyes with high myopia and high myopic astigmatism. Methods: We investigated 33 eyes of 18 consecutive patients (in a prospective, interventional case series study), with spherical equivalent errors of �6.00 to �21.09 diopters (D) and cylindrical errors of �0.5 to �4.75 D, who underwent ICL and TICL implantation. Before and after 5 days, 2 and 6 months of surgery, the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), defocus and adverse events of the surgery were assessed. Ocular HOAs were also evaluated by Hartmann-Shack aberrometry (Technolas PV, Rochester, New York, USA) before and after 6 months of surgery. Results: At 6.0 months after surgery, the UCVA and BCVA in 40 and 66.7 of eyes were 20/20, respectively. Mean defocus refraction and astigmatism was reduced to �0.66 and 0.65 D from �12.79 and 2.18 at baseline, respectively. For a 6 mm pupil, HOAs were not significantly changed, merely from 0.417 ± 0.162 μ before surgery to 0.393 ± 0.119 μ after surgery (P = 0.45). Spherical aberration (Z400) increased significantly (P = 00.0). Surgical induced astigmatism was lower than 0.25 D, and there were no changes in trefoils and coma aberration. No vision-threatening complications occurred during the observation period. Conclusion: This study shows that the ICL and TICL performed well in correcting high myopic astigmatism without significant changes in HOAs during a 6-month observation period, although the spherical aberration (Z400) increased significantly. © 2017 Iranian Society of Ophthalmolog

Ocular higher-order aberrations changes after implantable collamer lens implantation for high myopic astigmatism

Purpose: To investigate the changes in higher-order aberrations (HOAs) induced by the implantation of implantable collamer lenses (ICLs) and Toric ICL (TICL) in eyes with high myopia and high myopic astigmatism. Methods: We investigated 33 eyes of 18 consecutive patients (in a prospective, interventional case series study), with spherical equivalent errors of �6.00 to �21.09 diopters (D) and cylindrical errors of �0.5 to �4.75 D, who underwent ICL and TICL implantation. Before and after 5 days, 2 and 6 months of surgery, the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), defocus and adverse events of the surgery were assessed. Ocular HOAs were also evaluated by Hartmann-Shack aberrometry (Technolas PV, Rochester, New York, USA) before and after 6 months of surgery. Results: At 6.0 months after surgery, the UCVA and BCVA in 40 and 66.7 of eyes were 20/20, respectively. Mean defocus refraction and astigmatism was reduced to �0.66 and 0.65 D from �12.79 and 2.18 at baseline, respectively. For a 6 mm pupil, HOAs were not significantly changed, merely from 0.417 ± 0.162 μ before surgery to 0.393 ± 0.119 μ after surgery (P = 0.45). Spherical aberration (Z400) increased significantly (P = 00.0). Surgical induced astigmatism was lower than 0.25 D, and there were no changes in trefoils and coma aberration. No vision-threatening complications occurred during the observation period. Conclusion: This study shows that the ICL and TICL performed well in correcting high myopic astigmatism without significant changes in HOAs during a 6-month observation period, although the spherical aberration (Z400) increased significantly. © 2017 Iranian Society of Ophthalmolog

Foveal avascular zone and vessel density in healthy subjects: An optical coherence tomography angiography study

Purpose: To report the normal characteristics and correlations of the foveal microvascular networks using optical coherence tomography angiography (OCTA) in a healthy Iranian population. Methods: Enface 3x3 OCTA images were obtained using the RTVue Avanti spectral-domain optical coherence tomography with AngioVue software (Optovue, Fremont, CA, USA). Foveal avascular zone (FAZ) area, central foveal point thickness and inner retinal thickness at the foveal center and the vascular density of the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP) in the fovea were recorded. Results: Seventy normal eyes of 70 subjects (range, 9 to 71 years) were studied. Mean FAZ area was 0.32 ± 0.11 (range, 0.13-0.67) mm2 in SCP and 0.50 ± 0.13 (range, 0.19-0.94) mm2 in DCP. Mean SCP vessel density was 29.6 ± 4.7 (range, 16.3-40.3) in the fovea. Mean DCP vessel density was 27.0 ± 5.9 (range, 15.0-45.2) in the fovea. The FAZ area at SCP level was negatively correlated to the central subfield thickness (P &lt; 0.001). The FAZ area at DCP level correlated negatively to the central subfield thickness and was significantly associated to age (both P &lt; 0.001). The foveal SCP vessel density significantly correlated with foveal thickness and the foveal DCP vessel density correlated significantly with central foveal subfield thickness and was inversely related to age (all P &lt; 0.05). Conclusion: In this study, central foveal subfield thickness was a major determinant of the FAZ size and foveal vessel density. Age was a determinant for FAZ area and whole image vessel density in DCP. © 2018 Medknow Publications.All Rights Reserved

Intra-silicone Oil Injection of Methotrexate in Retinal Reattachment Surgery for Proliferative Vitreoretinopathy

Purpose: To evaluate the role of intrasilicone oil injection of methotrexate (MTX) at the end of vitrectomy surgery for rhegmatogenous retinal detachment (RRD) associated with proliferative vitreoretinopathy (PVR). Methods: In this prospective comparative study, pars plana vitrectomy and retinal reattachment were performed for eyes with RRD with grade C PVR. In the MTX group, 250 µg MTX was injected into the silicone oil at the end of surgery. The rate of retinal redetachment associated with PVR was assessed. Results: In total, 44 eyes of 44 patients (22 in the MTX group and 22 controls) were included. Baseline characteristics were similar between the two groups. Retinal redetachment occurred in one eye (4.5) in the MTX group and five eyes (22.7) in the control group (p = 0.18). The change in visual acuity was similar between the two groups at final visit (p = 0.15). Conclusion: The rate of redetachment associated with PVR was lower after intrasilicone injection of MTX at the end of vitrectomy for RRD with severe PVR compared to control group; however, the difference was not statistically significant. © 2019, © 2019 Taylor & Francis Group, LLC

Effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve implantation: A randomized control trial

Importance: The effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve (AGV) implantation. Background: Evaluation of efficacy and safety of subconjunctival Bevacizumab injection adjunctive to AGV implantation. Design: Prospective and randomized clinical trial. Participants: Fifty eyes of 50 patients with diagnosis of glaucoma that were candidate for AGV surgery were included. Methods: In 25 eyes, conventional AGV surgery (group 1) and in 25 eyes AGV surgery with subconjunctival Bevacizumab (group 2) was performed by block randomization Main Outcome Measures: The primary outcome measure was surgical success. Outcome measures were compared at postoperative month 3, 6 and 12. Results: Mean age of patients was 58.76 ± 12.11 and 51.36 ± 15.44 years in group 1 and 2 respectively (P = 0.06). Mean intraocular pressure (IOP) at baseline was 24.88± 7.62mmHg in group 1 and 27.52± 8.57mmHg in group 2 which decreased to15.4 ± 4.4 mmHg in group 1 and 13.42± 2.9 mmHg in group 2 (P < 0.00) at last follow up. Surgical success was defined in two level: postoperative IOP �21mmHg with at least 20 reduction in IOP (Criterion A), either with no medication (complete success) or with no more than two medications (qualified success) and criterion B with the same definition but the IOP �18mmHg The cumulative success according to criterion A and B was 77.8, 72.2 in group 1 and 89.5 in group 2, respectively, at the end of follow-up. Conclusions and Relevance: Subconjunctival injection of Bevacizumab adjunctive to AGV implantation leads to higher success rate compared with AGV alone in one year follow-up. © 2018 Royal Australian and New Zealand College of Ophthalmologists