Evaluation of Central Corneal Thickness after Cataract Surgery in Eyes with Pseudoexfoliation Syndrome

Purpose: To compare central corneal thickness after phacoemulsification in patients with and without pseudoexfoliation syndrome.Patients and Methods: A total of 130 eyes who were candidates for phacoemulsification (60 eyes with pseudoexfoliation syndrome and 70 eyes without pseudoexfoliation syndrome) in Shahid Sadoughi Hospital, Yazd, Iran were included in this prospective study. Before the surgery and one day postoperatively CCT were measured in all eyes using Lenstar LS 900 biometer (Haag-Streit(®)) and compared between the case and control groups. Results: Central corneal thickness before surgery was not significantly different between two groups (509 ± 29.28 µm in study group and 516 ± 32.11 µm in the control group, P = 0.27). Postoperatively, CCT in pseudoexfoliation group (589 ± 36.91 µm) was significantly higher than the control group (553 ± 32.77 µm) (P ˂ 0.001).  Conclusion: The mean central corneal thickness was significantly higher in patients with pseudoexfoliation compared to patients without pseudoexfoliation after cataract surgery. We suggest that phacoemulsification in cataract surgery candidates with pseudoexfoliation should be performed more carefully and with special considerations

Wolfram Syndrome presenting with optic atrophy and diabetes mellitus: two case reports

Wolfram syndrome is the constellation of juvenile onset diabetes mellitus and optic atrophy, known as DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness)

Diabetic retinopathy clinical practice guidelines: Customized for Iranian population

Purpose: To customize clinical practice guidelines (CPGs) for management of diabetic retinopathy (DR) in the Iranian population. Methods: Three DR CPGs (The Royal College of Ophthalmologists 2013, American Academy of Ophthalmology Preferred Practice Pattern 2012, and Australian Diabetes Society 2008) were selected from the literature using the AGREE tool. Clinical questions were designed and summarized into four tables by the customization team. The components of the clinical questions along with pertinent recommendations extracted from the above-mentioned CPGs; details of the supporting articles and their levels of evidence; clinical recommendations considering clinical benefts, cost and side effects; and revised recommendations based on customization capability (applicability, acceptability, external validity) were recorded in 4 tables, respectively. Customized recommendations were sent to the faculty members of all universities across the country to score the recommendations from 1 to 9. Results: Agreed recommendations were accepted as the fnal recommendations while the non-agreed ones were approved after revision. Eventually, 29 customized recommendations under three major categories consisting of screening, diagnosis and treatment of DR were developed along with their sources and levels of evidence. Conclusion: This customized CPGs for management of DR can be used to standardize the referral pathway, diagnosis and treatment of patients with diabetic retinopathy. © 2016 Journal of Ophthalmic and Vision Research

Intravitreal injection of anti-vascular endothelial growth factor agents for ocular vascular diseases: Clinical practice guideline

Purpose: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. Methods: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. Results: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. Conclusion: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients. © 2018 Journal of Ophthalmic and Vision Research

Intravitreal injection of anti-vascular endothelial growth factor agents for ocular vascular diseases: Clinical practice guideline

Purpose: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. Methods: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. Results: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. Conclusion: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients. © 2018 Journal of Ophthalmic and Vision Research

Serum lipids and diabetic retinopathy

Background: Diabetes Mellitus is the most common endocrinologic disease in human and retinopathy is one of the most common complications. Etiology of this complication is yet unknown but one of the factors that can be effective on its production or progression is serum lipid. We aim to study the relationship between different degrees of diabetic retinopathy and serum lipids levels. Methods: An observational cross-sectional study designed to study over 37 patients with diabetes mellitus type one and 157 patients with diabetes mellitus type two. Former was selected as sensus and latter was selected randomly from diabetic patients attending the diabetes clinic in Yazd during 2002. Inclusion criteria was duration of diabetes at least seven years from diagnosis. Statistical analysis performed by SPSS package edition 11 and wit statistical tests as Chi square, Fisher Exact and ANOVA. Results: Among 194 cases, 74 cases were males and 120 females. 90 cases (46.4%) have normal total serum cholesterol and 104 (53.6%) hypercholestrolemia. In case of triglyceride 94 cases (48.4%) have normal serum triglyceride and 100 (51.6%) hypertriglyceridemia. Distribution of different degrees of diabetic retinopathy was statistically significant due to cholesterol and triglycerides (P-Value<0.05). In different groups of sex, diabetic retinopathy was more prevalent if there was hypertriglyceridemia or hypercholesterolemia. This was correct about different groups of age and type of diabetes. This means that in different groups of age and type of diabetes, diabetic retinopathy was more prevalent if there was hypertriglyceridemia or hypercholesterolemia. Conclusion: Prevalence of diabetic retinopathy is higher in cases with hypertriglyceridemia or hypercholesterolemia than cases with normal serum triglyceride or cholesterole

PREVALENCE OF HYPERHOMOCYSTEINEMIA IN PATIENTS WITH RETINAL VEIN OCCLUSION

Recently multiple studies have shown that elevated homocysteine levels may be associated with ophthalmic vascular disease. To investigate the role of high plasma levels of homocysteine in the patients with retinal vein occlusion, 21 patients with retinal vein occlusion (RVO) and 20 age and sex matched controls without RVO were included in this retrospective case–control study. Information regarding sex, age, blood pressure, history of diabetes, history of glaucoma were obtained from all participants. Plasma level of homocysteine was measured by high plasma liquid chromatography. Mean plasma total homocysteine level was significantly higher in patients than controls (14.17  9.91 versus 8.97  3.10 mol/L, P < 0.031). Hyperhomocysteinemia was present in 5 of the 21 patients (25%) but only one control had elevated plasma homocysteine (5%). Hyperhomocysteinemia is highly associated with retinal vein occlusion; therefore, its measurement may be useful in the management of these patients

Accelerated Bilateral Cataract Formation as a First Manifestation of Diabetes Mellitus

There is a proved relationship between diabetes mellitus and the cataract formation. The incidence of this is usually related to the duration of diabetes. In this manuscript we report a 15 years old female presented to the emergency room with a 4 hour history of rapid bilateral diminished vision, initially diagnosed with idiopathic cataracts, but after more laboratory evaluations revealed new-onset type 1 diabetes mellitus without ketosis

Subconjunctival Bevacizumab Injection in Treatment of Pterygium

This study determined the clinical effect of subconjunctival administration of bevacizumab in patients with primary and recurrent pterygium. The study was an off-label, single-dosing, interventional case series involving 22 patients with primary and recurrent pterygium. They received subconjunctival bevacizumab (0.2cc). Pterygium vascularity and thickness was graded. The size of the pterygium (measured by surface area in cm2) was recorded from baseline to 12 weeks, after injection. Treatment-related complications and adverse events were reported. The main outcome of measurements was the change in size, vascularity, thickness, color intensity. There were 15 males (68.2%) and 7 females (31.8%) of 22 patients with a mean age of 45.5 years (SD 11.68 years). One cases didn't cooperate, and excluded. There was a significant difference in the mean surface area of pterygium at different intervals (P < 0.05) and the size of pterygium was reduced. On comparison of the mean pterygium size, there was no significant difference between men and women (P >0.05). There was a significant reduction in the mean pterygium size of patients younger than 45 years in comparison to those older than 45 years after three month (P =0.037), but after 6 months, this difference was not significant (P = 0.338). Average changes in pterygium size for both eyes were not different. The reduction of color intensity in both eyes was significant (P =0.031). Subconjuctival bevacizumab injection is useful in management of patients with primary and recurrent pterygium without significant local or systemic adverse effect