Guidance for Ophthalmologists and Ophthalmology Centers during the COVID-19 Pandemic

This is a Letter to the Editor and does not have an abstract

The role of Guidance and Planning on Safety of Ophthalmic Practice during the COVID-19 Pandemic

This is an Editorial and does not have an abstract

A 27-Year Report from the Central Eye Bank of Iran: A complete translation from Farsi

This article is based on a study first reported in Farsi in the Bina Journal of Ophthalmology, titled گزارش عملکرد سه دهه اي بانک چشم جمهوري اسلامي ايران, Volume 24, Issue 2 (Winter 2019) 2019/05/28. Original URL: https://www.sid.ir/fa/journal/ViewPaper.aspx?ID=487896 Purpose: To report the 27-year statistical data from the Central Eye Bank of Iran (CEBI) and its activity. Methods: All CEBI records regarding procured eyes, tissue utilizations, corneal transplants per capita, and indications for keratoplasty from 1991 to 2017 were analyzed. Results: In total, 115,743 whole eyes were donated during the 27-year period. Out of the 114,169 eyes donated between 1994 and 2017, 95,314 eyes were distributed for transplantation, and 95,057 corneas were actually transplanted. The mean annual rate of corneal transplants per capita was 55.10−6 ± 27.10−6. Although penetrating keratoplasty (PKP, 70%) was the most common technique of corneal transplantation during the study period, it exhibited a decreasing trend between 2006 and 2017 (P = 0.048). It was in contrast to Descemet stripping automated endothelial keratoplasty (DSAEK) that demonstrated an increasing trend during the same period (P < 0.001). Keratoconus (KCN, 39.70%) was the most leading indication for keratoplasty over the last three decades followed by bullous keratopathy (BK, 18.5%), corneal scar and opacities (15.7%), and graft failure (GF, 7.5%), with an increasing trend for BK, GF, and KCN. A majority of scleral tissues (83.7%) were utilized for orbital implant protection. Conclusion: An increasing trend in the number of procured eyes was observed over the past 27 years in Iran. The most leading indications for corneal transplantation were KCN and BK. While PKP was the most common keratoplasty technique, DSAEK showed an increasing trend over the last 12 years

Von Hippel-Lindau Disease and the Eye

Retinal hemangioblastoma (also referred to as retinal capillary hemangioma) is a benign lesion originating from the endothelial and glial components of the neurosensory retina and optic nerve head. Historically known as a manifestation of the von Hippel- Lindau (VHL) disease, it can be seen as an isolated finding or in association with some rare ocular conditions. In addition to characteristic ophthalmoscopic features, results of numerous ancillary tests including angiography, ultrasound, optical coherence tomography, and genetic tests may support the diagnosis and differentiate it from similar conditions. Because of serious life-threatening complications of VHL disease, every ocular approach to retinal hemangioblastomas should be in relationship with additional multidisciplinary diagnostic and therapeutic efforts. In addition, any patient with actual or probable diagnosis of VHL disease should be screened for ocular involvement. Unfavorable visual loss can occur early, and ocular complications of VHL range from exudative retinopathy to tractional retinal detachment, neovascular glaucoma, and phthisis bulbi. Accordingly, various treatment methods have been tested with overall acceptable responses, including photocoagulation, cryotherapy, photodynamic therapy, plaque radiotherapy, vitrectomy, and more novel intra-vitreal injections of anti-vascular endothelial growth factors and propranolol

Central Serous Chorioretinopathy in a Case of Regressed Familial Retinoblastoma

Purpose: To present a case of central serous chorioretinopathy (CSC) in association with regressed familial retinoblastoma. Case Report: A 23-year-old man with regressed unilateral familial retinoblastoma in his left eye presented with decreased vision of the left eye since two months ago. The patient had undergone chemotherapy and cryotherapy for the treatment of retinoblastoma 20 years ago. In the left eye, funduscopy disclosed regressed mass of retinoblastoma, inferonasal to the optic disc, and focal subfoveal neurosensory detachment. Optical coherence tomography (OCT) and fluorescein angiography revealed CSC. As there was no sign of recurrence of retinoblastoma and retinal findings did not show late-onset chemotherapy-related retinopathy, the patient was diagnosed with CSC and followed up. After two months, visual acuity of the left eye improved, and repeated macular OCT revealed absorption of the subretinal fluid. Conclusion: Subretinal fluid accumulation in a patient with regressed retinoblastoma is not always a sign of tumor recurrence or a treatment-related retinopathy

Variable Expressivity of Wolfram Syndrome in a Family with Multiple Affected Subjects

Purpose: To study the genetic basis and clinical manifestations of Wolfram syndrome in a multi-affected family. Methods: Complete clinical examinations including urological, ophthalmic, neurological, and endocrinologic assessment were performed for three affected family members. Genomic DNA was extracted from peripheral blood leukocytes with salting out method and all WFS1 exons and their flanking regions were sequenced. Candidate variation was screened for segregation in the pedigree by Sanger sequencing. Results: A known pathogenic missense mutation in WFS1 gene (c.1885C>T which leads to p.Arg629Trp in the encoded protein) was identified in all affected individuals. Both clinical and genetic investigations confirmed Wolfram syndrome diagnosis with variable phenotypic features. Conclusion: Identical mutations in the Wolfram syndrome causative gene can lead to variable manifestations of the syndrome even in the same family. Although the medical findings and clinical examination are imperative for the diagnosis of Wolfram syndrome, genetic testing is useful to confirm the diagnosis, especially in cases with possible reduced penetrance of the characteristic signs

Effects of Oral Vitamin D Supplement Therapy on Clinical Outcomes of Intravitreal Bevacizumab in Diabetic Macular Edema

Purpose: To assess the effects of oral vitamin D supplement therapy on clinical outcomes of intravitreal bevacizumab (IVB) injections in patients with diabetic macular edema (DME). Method: Seventy-one patients with center-involving DME received IVB injections three times monthly. Cases with serum 25-hydroxyvitamin D (25(OH)D) levels <30 ng/ml were divided into treatment and control groups. The treatment group received 50000 IU of oral vitamin D once a week for eight weeks. One month after the third IVB injection, changes in the best-corrected visual acuity (BCVA) and central macular thickness (CMT) were analyzed for each group. Results: Thirty-seven patients had sufficient levels of 25 (OH) D, while 34 patients had insufficient levels. Nineteen cases with deficient levels of 25(OH)D were treated with oral vitamin D, while 15 patients were assigned to the control group. The mean of serum 25(OH)D in patients was 27.9 ng/ml [mean 20.3 ± 5.4 and 17.3 ± 5.4 ng/ml in control and treatment groups, respectively (P = 0.231)]. After three IVB injections, BCVA improved significantly in each group, but the difference between the study groups was not statistically significant. CMT decreased significantly in all the groups. The mean CMT reduction was more prominent in the vitamin D-treated group, but the difference between groups did not reach statistical significance (P = 0.29). Conclusion: In DME patients with vitamin D deficiency, vitamin D supplement therapy had some beneficial effects on CMT reduction following three injections of IVB; nevertheless, these effects were not statistically significant. Definite conclusion needs further prospective studies with a larger sample size

Oral Vitamin D Supplementation and Clinical Outcomes of Intravitreal Bevacizumab Injection for Macular Edema Secondary to Retinal Vein Occlusions

Purpose: To evaluate the therapeutic response of retinal vein occlusion (RVO) to intravitreal bevacizumab (IVB) with and without concomitant vitamin D supplementation. Method: Seventy eyes of 68 patients with macular edema associated with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) received three monthly IVB injections. Patients with serum 25-hydroxyvitamin D (25(OH) D) higher than 30 ng/ml were considered as the sufficient group. Cases with serum 25(OH) D levels below 30 ng/ml were randomized into the treatment and control groups. The control group received 50,000 IU of oral vitamin D, weekly for two months. One month after the last IVB injection, best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured and compared with the preinjection values. Results: While 43 eyes (61.4%) of 42 patients had BRVO, 27 eyes (38.6%) of 26 patients had CRVO. In BRVO patients, changes of CMT and BCVA were not significantly different between the sufficient, control, and treatment groups (P = 0.58 and 0.64, respectively). In the CRVO group, CMT reduction in the control group was significantly less than the sufficient and treatment groups (P = 0.048). In addition, improvement of BCVA in the control group was significantly less (P = 0.036) than the sufficient and treatment groups. Conclusion: Oral vitamin D supplement therapy may improve anatomical and functional outcomes in patients with CRVO and vitamin D deficiency

Job Satisfaction among Ophthalmologists in Iran

Purpose: To estimate the level of job satisfaction among ophthalmologists in Iran and determine the associated factors that may impact their overall job satisfaction. Methods: In this cross-sectional study, 181 ophthalmologists (79.0% male) were interviewed by the Warr-Cook-Wall questionnaire with 7-point-Likert scale, which transformed responses from a 0 (most dissatisfied) to 100 (most satisfied). Questionnaires were randomly distributed among registered ophthalmologists at the 29th Annual Congress of the Iranian Society of Ophthalmology in November 2019. Satisfaction under each scale was considered as a score of >60% of the total score. Results: A total of 181 ophthalmologists with a mean age of 47.8 ± 12.1 years and 16 ± 12 years of practice participated in the present study. They were mostly satisfied with their job as a whole (88.1%, mean score: 60.6 ± 20.7) and dissatisfied with their income (55.9%, mean score: 47.6 ± 20.3). High levels of job satisfaction were found among ophthalmologists with longer duration of practice (P < 0.001) while lower levels of satisfaction were identified among those who worked in academic centers (P = 0.004). Conclusion: In this study, high levels of job satisfaction were found among ophthalmologists with longer duration of practice while low levels of satisfaction were identified among ophthalmologists who worked in academic centers. The factors of salary and working hours accounted for the least levels of job satisfaction