Optical coherence tomography angiography in intermediate uveitis-related cystoid macular edema

Background: Cystoid macular edema (CME) is the leading cause of permanent visual impairment in patients with uveitis, particularly in patients with intermediate uveitis (IU). This study was aimed at comparing the changes in the macular microvasculature in patients with IU with uveitic non-responsive CME and without macular edema. Methods: In this case-control study, 55 eyes of patients with IU were assessed for macular microvascular structures, including vascular density, foveal avascular zone (FAZ) measurement, and vascular morphological changes, using spectral-domain optical coherence tomography angiography (OCT-A) with the AngioVue OCT-A system. We divided patients into the following two groups: the case group, including 30 eyes with IU-related non-responsive CME, and the control group, including 25 eyes with IU without macular edema. Results: Participants in the case and control groups had comparable age (P = 0.753) and sex (P = 0.124) distributions. Superficial capillary plexus vessel density in the case group was significantly decreased in the whole image (P = 0.027) and the parafoveal area (P  = 0.001) compared to the control group. However, there were no statistically significant differences between the two groups in terms of foveal superficial vessel density, deep capillary plexus vessel density, FAZ area, FAZ perimeter, FAZ acircularity index, or foveal vessel density in a 300-µm-wide annulus around the FAZ (all P > 0.05). Vascular morphological changes, such as the capillary tuft, telangiectatic vessels, or micro-aneurism, were not different in the overview images of the OCT-A printout between the two groups. Conclusions: The mean superficial capillary plexus vessel density was lower in eyes with IU-related nonresponsive CME than in those without macular edema. We observed more cystoid spaces in SCP than in DCP. Microcystic changes in the inner retina and ischemia may be the underlying cause in eyes with nonresponsive CME. Future prospective longitudinal studies with healthy, matched controls are warranted to confirm our findings

Effects of repeated intravitreal bevacizumab administration on anterior segment parameters and limbal stem cells

Background: Macular edema (ME) is fluid accumulation in the macula caused by vascular leakage. Repeated intravitreal bevacizumab (IVB) injections are extensively used to treat ME of different origins, are well tolerated, and have few side effects. This study evaluated the effects of repeated IVB injections on the anterior segment parameters and limbal stem cells (LSCs) in eyes with ME. Methods: This before–after study involved patients with ME of different causes who underwent repeated IVB injections at the Imam Khomeini Ophthalmology Center in Kermanshah, Iran. Before and after repeated IVB injections, anterior segment parameters were measured using anterior segment optical coherence tomography, and the LSCs were assessed using impression cytology. Results: We enrolled 42 eyes of 42 patients with a mean (standard deviation [SD]) age of 59.6 (7.6) years, of whom 25 (59.5%) were men and 17 (40.5%) were women. The underlying diseases included diabetic ME in 30 eyes (71.4%), central (5 [11.9%]) or branch (3 [7.1%]) retinal vein occlusion, and choroidal neovascularization in 4 eyes (9.5%). The right eye was affected in 22 (52.4%) participants. The mean (SD) number of IVB injections was 4.3 (1.3). After repeated injections, the mean central corneal thickness (CCT) increased, whereas the mean anterior chamber angle (ACA) and anterior chamber depth (ACD) decreased (all P<0.001). Three patients developed LSC deficiency after repeated IVB injections for diabetic ME. Conclusions: We observed a significant increase in the mean CCT and a decrease in the mean ACA and ACD after repeated IVB injections in our series. Three patients developed LSC deficiency after repeated IVB injections for diabetic ME management. The observed effect on LSC may cast doubt on the safety of repeated IVB injections; however, this finding must be verified in multicenter clinical trials with longer follow-up periods and larger study samples

Pattern of Uveitis in Iran: A Systematic Review

Purpose: Uveitis is the third leading cause of blindness worldwide. This study aimed to summarize the pattern of uveitis in Iran through a systematic review. Methods: This review was conducted according to the guidelines for systematic reviews in the following four steps: literature search, study selection and assessment, inclusion and exclusion criteria, and statistical analysis. Results: One hundred and fifteen articles were identified by an encyclopedic literature search, and three independent investigators examined them according to the defined inclusion and exclusion criteria. Eventually, 109 manuscripts were retrieved and six cross-sectional studies covering 3,567 patients were included and reviewed. According to the results, the mean age of patients was 40 years, and sex was not a statistically significant predisposing factor. The most common anatomical pattern of involvement was anterior uveitis, and the prevalence of the other three types of uveitis, including middle, posterior, and pan-uveitis, were almost equal. Overall, the most common etiologies of uveitis in the Iranian population were idiopathic uveitis, toxoplasmosis, Behcet’s syndrome, and Fuchs heterochromic iridocyclitis. Conclusion: This study depicted the pattern of uveitis in Iranian society; this can help physicians in the diagnostic approach, management, and treatment of patients

Pattern and Visual Prognostic Factors of Behcet’s Uveitis in Northwest Iran

Purpose: To investigate the pattern of ocular involvement in Behcet’s disease (BD) with predictors of patients’ final state of vision. Methods: This historical cohort encompassed the clinical records of 200 patients diagnosed according to the International Criteria for BD (ICBD), over a period of 17 years between 2004 and 2021. Results: The prevalence of Behcet’s uveitis (BU) was more common in females and patients in the fourth decade of life. Ninety-five patients (47.5%) had evidence of ocular involvement in the initial ophthalmologic evaluation, and 171 patients (85.5%) manifested evidence of BU during the follow-up visits of which bilateral non-granulomatous panuveitis was the most common anatomical pattern of involvement (32.9%) followed by posterior (27.6%), anterior (26.5%), and intermediate (13.8%) uveitis. The prevalent accompanying signs were oral aphthous (67%), skin lesions (29%), and genital ulcers (19.5%). Cystoid macular edema (CME) was the most frequent ocular complication (62%), followed by cataract (57.5%) and epiretinal membranes (ERM) (36.5%). Univariate analysis showed the following determinants: male gender, younger age at onset, panuveitis, posterior uveitis, retinal vasculitis, and longer duration of uveitis as poorer visual prognostic factors of the disease. Multivariate analysis demonstrated a higher chance of poor visual prognosis of BD in patients with panuveitis, posterior uveitis, retinal vasculitis, and longer duration of uveitis. Conclusion: This cohort study demonstrated an overview on epidemiological patterns of BU along with the visual prognostic factors in Iranian patients

Comparison of Azithromycin and Pyrimethamine/Sulfadiazine Treatment in Ocular Toxoplasmosis in North West of Iran

Objective: Ocular toxoplasmosis (OT), characterized by necrotizing retinochoroiditis, scar formation and decreased vision, is recognized as the most prevalent cause of posterior uveitis in Iran. Although pyrimethamine/sulfadiazine combination remains the standard treatment particularly for patients with sight-threatening lesions, intolerance, inaccessibility and adverse drug reactions to this regimen have imposed us to seek for alternative treatments. Materials and Methods: In this prospective randomized control clinical trial study, 72 patients with active, non-vision threatening toxoplasmic chorioretinitis were randomly divided into 2 treatment regimen: 36 patients treated with standard protocol with pyrimethamine/sulfadiazine, and 36 patients received azithromycin for 6 weeks. All patients were followed up for 24 months. The clinical outcomes measured before and after intervention were, time to disease inactivity (lesion borders sharpening and scarring), changes in the size of retinochoroidal lesion, rate of recurrence, adverse drug reactions and visual acuity (VA). Results: No significant difference was noted between the 2 groups regarding age, gender, and VA before treatment. Significant improvement was noted in VA for each group during treatment. VA increased by 0.39 logMAR units in group 1 (P = 0.00) and 0.35 logMAR units in group 2 (P = 0.00). There was no statistically significant difference between the 2 groups concerning visual improvement (P = 0.33) and reduction in retinal lesion size and activity. There were totally 22 cases who experienced recurrences during the follow up period (4 [11.1%] patients of control group and 18 [50%] of intervention group [P = 0.00]), indicating significant lower recurrence in control group. Treatment tolerance was significantly better for the azithromycin group due to lower adverse drug reactions (P = 0.00). Conclusion: Azithromycin at a dose of 250 mg/d was shown to be effective for the treatment of active, non-vision threatening toxoplasmic retinochoroiditis similar to classic treatment with Pyrimethamine/Sulfadiazine regimen. However, recurrences and adverse drug reactions seem to differ significantly which notes the need for further studies and also vigilant selection of treatment protocols

Clinical Course of Uveitis in Children in a Tertiary Ophthalmology Center in Northwest Iran

Objective: In the present research, the clinical course of pediatric uveitis was studied by examining the demographic characteristics of afflicted children, the results of clinical examinations, and uveitis complications. Materials and Methods: The present research was a retrospective study in which the medical records of 243 children who had been visited and diagnosed as uveitis in the uveitis clinic of Nikookari Eye hospital of Tabriz in 2003-2015, were reviewed. The data were statistically analyzed by descriptive statistics and mean comparison tests in IBM-SPSS 23 and the significance level of P<0.05. Results:According to the results, 73 (30%), 146 (60.1%), 12 (4.9%), and 12 (4.9%) eyes diagnosed with uveitis had anterior, intermediate, posterior, and panuveitis type, respectively. In addition, 73 cases of uveitis (30%) were acute and 170 cases (70%) were chronic. Based on the LogMAR chart, the mean visual acuity before and after treatment was 0.39 and 0.15 for the right eye and 0.4 and 0.09 for the left eye, which suggests a significant difference. The most common complications observed in this study were macular edema (32.5%) and cataract (22.6%). Conclusion: This study indicates that intermediate uveitis is the most common type of pediatric uveitis, while anterior uveitis is the second. Posterior and panuveitis are less common in our study. The prevalence of chronic uveitis is significantly high in pediatric group which could justify the higher rate of complications in this age group

Comparison of the Effect of Low-Level Laser and Phenytoin Therapy on Skin Wound Healing in Rats

Introduction: Different modalities have been used to achieve better results in wound healing among which are laser and pharmacological agents. To our knowledge, there is no investigation to compare phenytoin and laser together. In this study, we aimed to evaluate laser and phenytoin efficacy and compare their effect on wound healing.Methods: We used 60 rats. The animals were divided into 4 groups, 15 rats in each and each group was subdivided into 3 subgroups for which postoperative evaluation was performed on days 3, 7, and 14. After general anesthesia and back hair shaving of each rat, an excisional wound was made. The wounds in group 2 were treated with 1% phenytoin cream. In group 3, the wounds were irradiated with diode laser. The wounds of group 4 were treated with both phenytoin cream and laser administration. The animals of group 1 served as control. For histopathological evaluation, hematoxylin and eosin staining was used. Polymorphonuclear leucocytes (PMNs), re-epithelization, fibroblasts, new vessels and collagen were evaluated.Results: Faster reduction in polymorphonuclear cells after 7 and 14 days and more collagen fibers on the third day in laser treated group was statistically significant (P &lt; .05) .The result for the phenytoin treated group were not better than control group. When both laser and phenytoin were used samples showed more collagen fibers on the third day, which was statistically significant (P &lt; .05).Conclusion: It seems that low level laser is effective in skin wound healing and have better results than phenytoin application

Opium use and risk of mortality from digestive diseases: A prospective cohort study

Objectives:Opium use, particularly in low doses, is a common practice among adults in northeastern Iran. We aimed to investigate the association between opium use and subsequent mortality from disorders of the digestive tract.Methods:We used data from the Golestan Cohort Study, a prospective cohort study in northeastern Iran, with detailed, validated data on opium use and several other exposures. A total of 50,045 adults were enrolled during a 4-year period (2004-2008) and followed annually until December 2012, with a follow-up success rate of 99. We used Cox proportional hazard regression models to evaluate the association between opium use and outcomes of interest.Results:In all, 8,487 (17) participants reported opium use, with a mean duration of 12.7 years. During the follow-up period 474 deaths from digestive diseases were reported (387 due to gastrointestinal cancers and 87 due to nonmalignant etiologies). Opium use was associated with an increased risk of death from any digestive disease (adjusted hazard ratio (HR)=1.55, 95 confidence interval (CI)=1.24-1.93). The association was dose dependent, with a HR of 2.21 (1.57-3.31) for the highest quintile of cumulative opium use vs. no use (P trend =0.037). The HRs (95 CI) for the associations between opium use and malignant and nonmalignant causes of digestive mortality were 1.38 (1.07-1.76) and 2.60 (1.57-4.31), respectively. Increased risks were seen both for smoking opium and for ingestion of opium.Conclusions:Long-term opium use, even in low doses, is associated with increased risk of death from both malignant and nonmalignant digestive diseases

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations