Short-term Outcomes of Saffron Supplementation in Patients with Age-related Macular Degeneration: A Double-blind, Placebo-controlled, Randomized Trial

In modern pharmacological medicine, saffron is used for various purposes due to its antioxidant effect. This study evaluated retinal function after treatment with saffron supplementation during a follow-up period of 6 months to provide further insight into the efficacy and safety considerations of this treatment. Sixty patients with wet or dry age-related macular degeneration (AMD) were randomly assigned to receive oral saffron 30 mg/d or placebo supplementation for 6 months. Optical coherence tomography (OCT), electroretinography (ERG), fluorescein angiography, and visual acuity testing were performed at baseline and 3 and 6 months after treatment. The main outcome measures were OCT, ERG amplitude, and implicit time. Six months after treatment, no statistically significant decrease in OCT results was observed between the groups with dry AMD (P = 0.282). However, there was a statistically significant increase in ERG results between the groups at 3 months after treatment (P = 0.027). In addition, there was a significant decrease in OCT results between groups with wet AMD at the follow-up (P = 0.05). Finally, there was a significant increase in ERG findings between the groups with wet AMD at 3 months after treatment (P = 0.01), but these changes decreased at 6 months after treatment (P = 0.213). Daily supplementation with 30 mg of saffron for 6 months may result in a mid-term, significant improvement in retinal function in patients with AMD.Â

Schwann Cell-Mediated Preservation of Vision in Retinal Degenerative Diseases via the Reduction of Oxidative Stress: A Possible Mechanism

After central nervous system (CNS) injuries, the regeneration process does not work out well except for remyelination process. This remyelination capacity in CNS can be mentioned as a worthy example of stem/precursor cell-mediated renewal process. Remyelination in CNS is mediated by Schwann cells which act mainly as remyelinating agents in peripheral nervous system (PNS) but several studies have shown their potential role in CNS too. Schwann cells have the capacity of supporting and saving retinal cells by secreting growth factors like:  Brain-derived neurotrophic factor (BDNF), Glial cell-derived neurotrophic factor (GDNF), and Basic fibroblast growth factor (bFGF) in subretinal space. Retinal degenerative diseases are one of the most important debilitating concerns in modern countries which has encountered the problem of ageing population. One of the best examples of retinal degenerative disease which is a leading cause of permanent visual loss in Western world is age related macular degeneration (AMD). In United States it is believed that nearly 1.75 million, older than 40 years have end stages of this debilitating disease, and it is estimated that this number will progress to approximately 3 million people by year 2020. One of the most common pathways which is involved in initiation and development of retinal disease is called Oxidative stress. Schwann cells are capable of secreting high amounts of antioxidant enzymes which protect PNS in front of oxidative stress which is result of glucose fluctuation in diabetic patients. The antioxidant role of Schwann cells in PNS may be the possible mechanism which can make Schwann cells potent reconstructing agents in CNS and especially in retinal injuries and retinal degenerative disease

Schwann Cell-Mediated Preservation of Vision in Retinal Degenerative Diseases via the Reduction of Oxidative Stress: A Possible Mechanism

After central nervous system (CNS) injuries, the regeneration process does not work out well except for remyelination process. This remyelination capacity in CNS can be mentioned as a worthy example of stem/precursor cell-mediated renewal process. Remyelination in CNS is mediated by Schwann cells which act mainly as remyelinating agents in peripheral nervous system (PNS) but several studies have shown their potential role in CNS too. Schwann cells have the capacity of supporting and saving retinal cells by secreting growth factors like:  Brain-derived neurotrophic factor (BDNF), Glial cell-derived neurotrophic factor (GDNF), and Basic fibroblast growth factor (bFGF) in subretinal space. Retinal degenerative diseases are one of the most important debilitating concerns in modern countries which has encountered the problem of ageing population. One of the best examples of retinal degenerative disease which is a leading cause of permanent visual loss in Western world is age related macular degeneration (AMD). In United States it is believed that nearly 1.75 million, older than 40 years have end stages of this debilitating disease, and it is estimated that this number will progress to approximately 3 million people by year 2020. One of the most common pathways which is involved in initiation and development of retinal disease is called Oxidative stress. Schwann cells are capable of secreting high amounts of antioxidant enzymes which protect PNS in front of oxidative stress which is result of glucose fluctuation in diabetic patients. The antioxidant role of Schwann cells in PNS may be the possible mechanism which can make Schwann cells potent reconstructing agents in CNS and especially in retinal injuries and retinal degenerative disease

Intravitreal Medications for Retinal Vein Occlusion: Systematic Review and Meta-analysis

Purpose: To evaluate the outcomes of different intravitreal injections for the treatment of retinal vein occlusion including central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Methods: PubMed, Cochrane, the metaRegister of ControlledTrials, and ClinicalTrials were searched for intravitreal anti-Vascular Endothelial Growth Factor (VEGF) and steroids with relevant keywords and date limitation of 2009-2018. Meta-analysis was performed on studies that met the defined inclusion criteria. Main outcomes were visual acuity (VA) and central macular thickness (CMT). Results: Out of 681 studies, 36 articles (including 21 reporting CRVO and 15 dealing with BRVO) were selected for systematic review. All five intravitreal drugs including triamcinolone, dexamethasone, ranibizumab, bevacizumab, and aflibercept showed improvement of CMT and VA as compared to placebo or laser treatment. Six randomized controlled trials were selected for meta-analysis in RVO patients. The pooled mean difference of visual improvement between sham and ranibizumab was 12.7 Early Treatment for Diabetic Retinopathy Study (ETDRS) letters (95%CI: 11.00 to 13.2), and the pooled mean difference in CMT reduction was 221 μm (95%CI: 153 to 284); both changes were significantly in favor of ranibizumab. The pooled mean difference of visual improvement between bevacizumab and triamcinolone was 5.3 ETDRS letters in favor of bevacizumab (95%CI: 16 μm to 17.5 μm). Triamcinolone led to 68.1 μm greater CMT reduction than bevacizumab (95%CI: 58 μm to 76 μm). However, none of these differences were statistically significant. Conclusion: Treatment with anti-VEGF agents in RVO is superior to observation. No significant difference was seen between the eyes treated with bevacizumab or triamcinolone based on these results

Role of Schwann Cells in Preservation of Retinal Tissue Through Reduction of Oxidative Stress

The aim of this study was to evaluate the effect of subretinal injection of Schwann cells on preservation of retina by decreasing oxidative stress in Dystrophic Royal College of Surgeons (RCS) rats. Schwann cells were harvested from the sciatic nerve of postnatal day 5, RCS rats. Twenty-five RCS rats randomly assigned to cell and sham groups. Schwann cells injected in the sub-retinal space in one eye of the cell group and carrier medium was injected in one eye of the sham group. The proof for the appropriate site of injection of Schwann cells confirmed by the green fluorescent protein (GFP) positive cells. Electroretinogram (ERG) and enucleation for histopathology and enzymatic evaluation were performed 1, 2 and 3 months post-injection. The enzymatic evaluation included catalase, superoxide dismutase (SOD) and glutathione peroxidase 1 (GPx1) by enzyme-linked immunosorbent assay (ELISA) method. Three months after injection, histopathology assessments showed a complete absence of the outer nuclear layer (ONL), photoreceptors and obvious reduction of retinal pigment epithelium (RPE) in the sham group. Cell group showed marked preservation of RPE, choroidal congestion and mild presence of ONL. The green fluorescent protein positive Schwann cells remained in one integrated layer during the study under RPE. The enzymatic evaluation showed that in cell group expression of SOD and GPx1 until month 2 and catalase until month 1 were significantly more than the sham group. At the end of month 3, the amplitude of ERG waves significantly preserved in cell group in comparison to baseline waves and the sham group. We concluded that Schwan cells are able to preserve retinal in RCS rats by reducing oxidative stress. Epub: October 1, 2019

Oguchi Disease Associated with Keratoconus

This is a Photo Essay and does not have an abstract. Please download the PDF or view the article in HTML

Safety of Intravitreal Injection of Stivant, a Biosimilar to Bevacizumab, in Rabbit Eyes

Purpose: To evaluate the safety of intravitreal injection of Stivant, a biosimilar to bevacizumab, in rabbits using electrophysiological and histological analysis. Methods: Both eyes of 41 New Zealand albino rabbits were injected with 0.1 mL (2.5 mg) of Stivant. The rabbits were scheduled to be sacrificed 1, 2, 7, 14, and 28 days after injection for histopathological evaluations. Clinical examinations and electroretinography (ERG) were performed at baseline and just before sacrificing the rabbits. Fourteen separate rabbits received a reference drug (Avastin) and were considered as the control group. Furthermore, three other rabbits received the same volume of saline (saline control group). Rabbits of both control groups were sacrificed four weeks after injection. ERG was performed 1, 2, 7, 14, and 28 days after injections. Results: No significant difference was observed in a- and b-wave amplitudes and latency after intravitreal Stivant injection between baseline and different time points. Moreover, there was no statistically significant difference in wave amplitudes and latency between the Stivant and control groups. The histology of rabbit eyes of the Stivant and control groups after intravitreal injections was not distinguishable. Conclusion: The biosimilar Stivant, up to a dose of 2.5 mg, did not appear to be toxic to the retina in albino rabbits. These results suggest that this drug could be a safe and inexpensive alternative to intravitreal bevacizumab. The efficacy of these injections was not investigated in this study and needs to be evaluated in future studies

A Comparison between Prophylactic Vitrectomy and Laser Photocoagulation in Treatment of Acute Retinal Necrosis Syndrome

Purpose: To compare the results of prophylactic pars plana vitrectomy with barrier laser photocoagulation in treatment of acute retinal necrosis (ARN). Patients and Methods: Fifteen ARN patients were retrospectively included in this study. At presentation, all patients had severe vitreous involvement without any detectable break or retinal detachment (RD), either in funduscopy or echography exams. All patients received intravenous acyclovir 2 g/daily for two weeks. Eight patients underwent prophylactic vitrectomy and seven patients underwent barrier laser photocoagulation after resolution of vitritis. Visual and structural outcomes were compared between the two groups. Results: In eight vitrectomized patients, one patient (12.5 %) experienced RD. The mean best corrected visual acuity (BCVA) improved significantly in this group (P=  0.027). Among seven patients undergoing barrier laser photocoagulation, 3 patients (43 %) developed RD and BCVA improvement was not significant (P=  0.207). Comparison between the two groups did not show any statistically significant benefit when comparing post treatment BCVA (P=  0.59) or RD prevention (P=  0.282). Conclusion: Early prophylactic vitrectomy, in the course of ARN has been suggested as a useful method in preventing RD and improving the visual outcome, but the results of the present study did not indicate any significant benefit for vitrectomy compared to barrier laser photocoagulation. Further studies with bigger sample size are recommended to compare these two methods of treatment.Keywords: Retinal necrosis syndrome; Acute; Treatment outcome; Vitrectomy; Retinal detachment

Intraocular Injection of Stivant® (A Biosimilar to Bevacizumab): A Case Series

Purpose: To report the results of intravitreal injection of a bevacizumab biosimilar called Stivant®. Methods: This prospective interventional case series was conducted on eyes with neovascular age-related macular degeneration (nAMD), retinal vein occlusion (RVO), and diabetic macular edema (DME). Stivant® was injected in three consecutive months and changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and monthly up to one month after the third injection. Results: Three hundred and eighty-five eyes with DME (234 eyes, 61%), nAMD (87 eyes, 22%), and macular edema secondary to RVO (64 eyes, 17%) were enrolled. The mean ± standard deviation age of the patients was 61.7 ± 7.20 years. The mean BCVA and CMT changed from 0.63 ± 0.3 to 0.51 ± 0.3 LogMAR (P = 0.12 ) and from 420.4 ± 47.3μm at baseline to 316.7 ± 50.6 μm (P < 0.001) in the DME group; from 0.79 ± 0.3 to 0.68 ± 0.3 LogMAR (P = 0.19) and from 376.1 ± 31.7 μm to 303 ± 31.3 μm (P = 0.019) in the nAMD group; and from 0.81 ± 0.4 to 0.63 ± 0.4 LogMAR (P = 0.05) and from 424.21 ± 18 μm to 303.4 ± 18.8 μm (P < 0.001) in the RVO group, respectively. Conclusion: Our limited experience showed that the intravitreal injection of Stivant® was well tolerated. Although the results of this case series showed relative improvement in CMT one month after the last injection of Stivant®, BCVA improvement was statistically significant only in the RVO group. This would be essential to design a randomized clinical trial to evaluate the non-inferiority of Stivant® in comparison to bevacizumab

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