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Purpose: To evaluate the short-term additive effects of topical ketorolac to intravitreal bevacizumab (IVB) in the management of center-involved diabetic macular edema (CI-DME). Methods: In a randomized double-masked placebo-controlled crossover clinical trial, eyes with CI-DME and the best-corrected visual acuity (BCVA) between (20/40) and (20/400) were included. These eyes should have had at least one intravitreal anti-VEGF injection in the preceding two months. They were randomized into two groups; while both groups received two IVB injections with a six-week interval, one group received topical ketorolac every 6 hr in the first interval and artificial tears every 6 hr as a placebo in the second interval and the other group received the same medications using a crossover method. The main outcome measures were changes in BCVA and central macular thickness (CMT) . Results: Fifty-seven eyes of 35 patients with CI-DME were included in the study. The mean BCVA improvement was --0.09 ± 0.47 logMAR in the periods of receiving ketorolac and --0.03 ± 0.12 logMAR in the periods of placebo treatment, respectively (P = 0.99). Corresponding changes in CMT were --13.1 ±170.1 and +11.7 ±157.7 µm in the ketorolac and placebo periods, respectively (P = 0.322). The treatment effect was not statistically significant regarding both BCVA and CMT changes. Statistical analysis also disclosed that the carryover effect was insignificant for BCVA and CMT. Although the period effect was not significant for BCVA, it was at a meaningful level for CMT changes (P = 0.012). Conclusion: This crossover clinical trial demonstrated that in the course of DME treatment with IVB injections, topical ketorolac did not have any additive beneficial effect at least during a six-week period. [ABSTRACT FROM AUTHOR]

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 was 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. [ABSTRACT FROM AUTHOR]

Purpose: To estimate carrier frequencies of CYP1B1 mutations p.Gly61Glu and p.Arg368His, respectively, in Talesh and the east of Guilan province in Iran with a maximum error of 2%. Previously, it was shown that these CYP1B1 mutations may be relatively prevalent in these regions. Methods: Population-based screenings were performed. DNA was extracted from saliva samples of 1036 individuals from Talesh and 3029 individuals from the east of Guilan. P.Gly61Glu and p.Arg368His screenings were performed, respectively, by RFLP and ARMS-based PCR protocols. For confirmation, the DNA of individuals with mutations was sequenced using the Sanger protocol. Results: Nine individuals from Talesh (0.86%; 95%CI: 0.45--1.64%) carried the p.Gly61Glu mutation, and 73 from the east of Guilan (2.41%; 95%CI: 1.91--3.04%) carried p.Arg368His. There was no significant difference in frequencies between urban and rural regions of the various cities, nor among four cities within the east of Guilan. Conclusion: The frequencies of p.Gly61Glu carriers in Talesh and of p.Arg368His carriers in the east of Guilan were within the 95% confidence interval of a previous study based on screenings of fewer individuals. The reliability of the recent estimates is higher, as the confidence interval for p.Gly61Glu decreased from 6.5% to 1.19% and the interval for p.Arg368His decreased from 4% to 1.13%. Based on the new findings, the maximum expected frequency of p.Gly61Glu carriers in Talesh is 1.64%, and of p.Arg368His carriers in the east of Guilan is 3%. The need for performing premarital screenings in the respective cities can be evaluated. [ABSTRACT FROM AUTHOR]

Purpose: To assess the efficacy and survival rate of the Trabectome-mediated ab interno trabeculectomy combined with non-fenestrated Baerveldt glaucoma implant compared with the Baerveldt glaucoma implant alone. Method: In this retrospective comparative case series, 175 eyes undergoing primary glaucoma surgery (Baerveldt--Trabectome [BT] group: 60 eyes and Baerveldt [B] group: 115 eyes) were included. Participants were identified using the procedural terminology codes. Groups were then matched by Coarsened Exact Matching that resulted in the inclusion of 51 eyes in each group. The primary outcome measure was surgical success defined as 5 mmHg < intraocular pressure (IOP) ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline, and no need to reoperation for glaucoma. Secondary outcome measures were IOP, number of glaucoma medications, and best-corrected visual acuity (BCVA). Results: The cumulative probability of success at one year was 61% in the BT group and 50% in the B group. IOP decreased from 23.5 ±2.4 mmHg at baseline to 14.1 ±2.7 mmHg at the final follow-up in the BT group (P = 0.001). The corresponding values for the B group were 23.2 ± 2.0 mmHg and 13.9 ± 1.6 mmHg, respectively (P = 0.001). There was no significant difference between the groups in terms of IOP at the final follow-up (P = 0.56). The number of medications at baseline was 2.3 ±0.3 in both groups. However, the BT group needed fewer drops at all postoperative time intervals and used 1.1 ±0.3 versus 2.0 ±0.4 eye drops (group B) at the final follow-up visit (P = 0.004). Eyes in B with phacoemulsification had a significantly higher IOP on day 1 compared to B (23.2 ±14.3 versus 17.9 ±11.4, P = 0.041). During the oneyear follow-up, 7 (13.7%) patients in BT group and 18 (35.2%) in B group experienced hypotony (P = 0.04). No dangerous hypotony or hypertension occurred in BT group. The mean BCVA at baseline was 0.64 ±0.85 logMAR and changed to 0.55 ±0.75 logMAR in BT and B groups, respectively (P = 0.663). The corresponding numbers for the final follow-up visit was 0.72 ± 1.07 and 0.63 ±0.97 logMAR, respectively (P = 0.668). Conclusion: We observed similar rates of success and IOP reduction using BT and B techniques. BT group needed fewer glaucoma medications. Tube fenestration was unnecessary in BT group resulting in less postoperative ocular hypotony and hypertension. The results of our study indicate that additional trabectome procedure makes Baerveldt glaucoma implant safer, easier to handle, and more predictable in the most vulnerable patients with advanced glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To compare the choroidal thickness in eyes with acute non-arteritic anterior ischemic optic neuropathy (NAION) with healthy contralateral eye and normal controls. Methods: Thirty-eight eyes with NAION, thirty-eight unaffected fellow eyes, and seventy-four eyes from 37 healthy, age- and sex-matched subjects were included in this prospective comparative case-control study. Choroidal thickness was measured by enhanced depth imaging (EDI) of spectral domain optical coherence tomography (SD-OCT). Peripapillary choroidal thickness (PCT) was measured at 1000 and 1500 µm from Bruch's membrane opening (BMO). Subfoveal choroidal thickness (SFCT) was measured in central subfoveal area, and 500 microns apart in temporal and nasal sides. Choroidal thickness among NAION eyes, uninvolved fellow eyes, and control eyes were compared. Results: The mean of PCT at1000 µm was significantly thicker in NAION and fellow eyes compared to control eyes (169.7 ± 47,154.4 ± 42.1, and 127.7 ± 49.9 µm, respectively, P < 0.001 and P = 0.42). The mean PCT at 1500 µm was also significantly thicker in NAION and fellow eyes compared to control eyes (178.6 ± 52.8,162.6 ± 46.1, and 135.1 ± 59 µm, respectively, P = 0.007 and P = 0.048). The mean PCT at 1000 and 1500 µm was significantly greater in NAION compared to fellow eyes (P = 0.027 and P = 0.035, respectively). The mean of SFCT was significantly thicker in NAION compared to control eyes (P = 0.032); however, there was no significant difference between uninvolved fellow and control eyes (P = 0.248). Conclusion: Thicker choroidal thickness in acute NAION and uninvolved fellow eyes compared to normal eyes suggests a primary choroidal role in NAION pathophysiology. [ABSTRACT FROM AUTHOR]

Purpose: To compare the surgical outcomes of slanted versus augmented recession in patients with horizontal strabismus. Methods: In this randomized clinical trial, a total of 100 esotropic (ET) and exotropic (XT) patients with a high AC/A ratio which was defined as a difference of ≥ 10 prism diopters (pd) between the distance and near deviations were included if the patients had a distance deviation ≥15 pd. Patients were randomly assigned into the slanted (n = 26 in ET and n = 24 in XT group) and augmented recession groups (n = 25 in ET and n = 25 in XT group). In the slanted group, recession was performed on the superior and inferior poles of the muscle based on the distance and near deviations, respectively, while in the augmented recession group, the muscles were recessed 1.00 or 1.50 mm more than the standard amount according to the distance and near difference between 10 and 20 pd or >20 pd, respectively. Results: The mean age was 9.8 ± 9.6 years and 63% were female. There was a significant postoperative reduction of difference in convergence excess in ET cases compared to patients who underwent the augmented recession procedure (12.65 ± 6.16 vs 8.64 ± 6.1 pd, P = 0.014). Among our XT groups, there was no significant difference in postoperative reduction in the XT angle in the slanted group compared with the augmented group (P >0.05). Conclusion: Slanted recession is recommended in convergence excess ET patients. In XT patients, either slanted or augmented recession may be chosen according to the priority and experience of the surgeon. [ABSTRACT FROM AUTHOR]

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 221µm (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 µvm). 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. [ABSTRACT FROM AUTHOR]

Purpose: To perform a population-based screening of four CYP1B1 mutations—p.Gly61Glu, p.Arg368His, p.Arg390His, and p.Arg469Trp—in the province of Gilan, Iran. Previous studies have shown that CYP1B1 is a cause of disease in approximately 70% of Iranian patients with primary congenital glaucoma (PCG), and that these four mutations constitute the majority of CYP1B1 mutated alleles. The carrier frequencies may even justify premarital screenings. Methods: DNA was extracted from the blood samples of 700 individuals recruited in a population-based epidemiology study in Gilan. Screenings were performed using polymerase chain reaction protocols based on restriction fragment length polymorphism or the amplification-refractory mutation system. For confirmation, the DNA of individuals with mutations was sequenced using the Sanger protocol. Results: Five individuals carried the p.Gly61Glu mutation, and seven carried the p.Arg368His mutation. The p.Arg390His and p.Arg469Trp mutations were not observed in any of the 700 individuals screened. The mutations were not geographically randomly distributed in Gilan; four of the p.Gly61Glu-harboring individuals were from Talesh, and six of the p.Arg368His-harboring individuals were from the eastern regions of Gilan. Conclusion: The frequency of individuals who carry either p.Gly61Glu or p.Arg368His is relatively high in Gilan, and notably high in certain localities within Gilan. We suggest further screenings be performed to definitively assess the need for implementing measures to encourage screening for p.Gly61Glu and p.Arg368His before marriage in Talesh and the eastern regions of Gilan, respectively. Finally, our assessment showed that regional frequencies of CYP1B1 mutations do not necessarily mirror national frequencies. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prognostic factors and visual and anatomic outcomes of pars plana vitrectomy (PPV) in patients with dropped nucleus following complicated phacoemulsification (PE). Methods: The records of patients with complicated PE who underwent PPV to remove posteriorly dislocated nucleus fragments from January 2011 to December 2014 were retrospectively reviewed. Results: Of 43 patients, 36 patients (36 eyes) were included with mean age of 73 ± 9.5 years and mean follow-up duration of 23.8 ± 15.3 (range 4–53) months. The mean interval between cataract surgery and PPV was 11.5 ± 9.6 (range 1–45) days. The pre-PPV mean best-corrected visual acuity (VA) was 1.04 ± 0.24 logMAR, which improved to 0.46 ± 0.18 logMAR (P < 0.001). Pre-PPV VA ≥20/200 was significantly associated with good final VA ≥20/40 (P = 0.002). Implantation of intraocular lens (IOL) at the time of complicated PE and complicated course after PPV were significantly associated with poor visual outcome of <20/40 (P = 0.041 and P < 0.001, respectively). However, the timing of PPV, route of nucleus removal, and final IOL status were not significantly associated with the visual outcome. The most frequent causes of poor visual outcome were optic atrophy, cystoid and/or diabetic macular edema, history of rhegmatogenous retinal detachment, and pre-existing eye disease (age-related macular degeneration). Conclusion: PPV for dropped nucleus was associated with improved VA. Better pre-PPV VA was associated with good visual outcome, while inserting IOL at the time of complicated PE, and complicated course after PPV were associated with poor visual outcome. [ABSTRACT FROM AUTHOR]

Purpose: To report the long-term results of intravitreal bevacizumab (IVB) injection alone or combined, at the time of first IVB injection, with intravitreal triamcinolone acetonide (IVT) for treatment of refractory diabetic macular edema (DME). Methods: In this randomized clinical trial, 115 eyes of 101 patients with refractory DME were enrolled and randomly assigned to one of the three study arms: the IVB group (41 eyes) received three consecutive injections of 1.25 mg IVB at 6-week intervals; the IVB/IVT group (37 eyes) additionally received 2 mg of IVT at the time of first IVB injection; and the control (sham injection) group. Patients in the IVB and IVB/IVT groups were followed for a mean of 13.3 months and received retreatment with IVB alone whenever indicated. Main outcome measures were best corrected visual acuity (BCVA) and central macular thickness (CMT). Results: At the last follow up, CMT decreased significantly in the IVB group (p=0.013) but it was not significant (p=0.13) in the IVB/IVT group. Mean CMT improvement was 91 (95% CI, 20 to 161) microns and 57 (95% CI, -18 to 133) microns in the IVB and IVB/ IVT groups, respectively. Mean BCVA improvement from baseline was 0.28 (95% CI, 0.18 to 0.38) logMAR (P=0.017) in the IVB group and 0.19 (95% CI, 0.08 to 0.30) logMAR (P=0.001) in the IVB/IVT group. There was no difference between the two groups in terms of visual improvment (p=0.42). In generalized linear mixed model, only the time interval between the last injection and CMT measurement was statistically significant (P=0.04). The same results were repeated for visual acuity (P=0.03). Conclusion: Three loading doses of IVB (added doses if required) have long-term beneficial effects for treatment of refractory DME. Adding triamcinolone to this regimen provides no additional long-term benefit. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate refractive state in children with unilateral congenital nasolacrimal duct obstruction (NLDO). Methods: This descriptive cross-sectional study includes consecutive children with unilateral congenital NLDO. Examination under anesthesia was performed to perform cycloplegic refraction and was followed by appropriate intervention in each patient. Refractive errors of the involved and sound fellow eyes were compared. Results: Ninety-four children with mean age of 25.4±20.4 months (range, 6 months to 10 years) were enrolled from May 2007 to January 2010. Based on spherical equivalent refractive error, hyperopia was more common in the affected eyes, however this difference failed to reach statistical significance (P=0.5). Anisometropia more and less than 0.5 diopters (D) was present in 25% and 43% of patients respectively. Interocular difference was significant in terms of spherical refractive error and spherical equivalent (P=0.003) but not cylindrical refractive error. When the comparison was limited to hyperopic eyes, the interocular difference became more significant in terms of spherical refractive error and spherical equivalent (P<0.001). Each month of increase in age was associated with an interocular difference of 0.007D in spherical refractive error (r=0.242, P=0.02). Older age at the time of intervention was associated with more procedures (r=0.297, P=0.004). Conclusion: Unilateral congenital NLDO is associated with anisometropia especially anisohyperopia which may predispose affected children to amblyopia. With increasing age, the degree of anisometropia and the number of required procedures increase. It is prudent to perform refraction and initiate proper intervention at a younger age. [ABSTRACT FROM AUTHOR]

Purpose: To compare quality of life (QOL) in myopic patients who underwent photorefractive keratectomy (PRK) with that of myopic spectacle or contact lens users. Methods: This observational comparative study was performed on 102 low to moderate myopic patients who had undergone PRK at least 6 months ago and 106 myopic spectacle or contact lens wearers. Vision related QOL and its correlation with demographic variables, visual acuity and refractive status were compared between the two groups. QOL was measured using a validated translated version of the Visual Function Questionnaire (VFQ-25) which contains 25 questions in 12 subscales with a total score of zero to 100. Results: Mean total QOL score was 97.0±4.4 and 86.1±10.7 in PRK and nonsurgical groups respectively [mean difference (d)=11, P<0.001]. The difference was independent of age, sex, education or marital status (P>0.05). Overall, 10 out of 12 QOL subscales were significantly higher in the PRK group (P<0.001) especially general vision (d=23.8), general health (d=22.2), driving (d=19.3), role difficulties (d=14.6), distance activities (d=13.8) and mental health (d=13.7). Only color vision (d=1.6, P>0.9) and ocular pain (d=3.1, P=0.3) were not significantly different between the study groups. Conclusion: Correction of myopia using PRK is associated with higher QOL scores in most subscales as compared to spectacle or contact lens wear. [ABSTRACT FROM AUTHOR]

Purpose: To compare anterior segment and ocular biometric parameters in unaffected fellow eyes of patients with a previous attack of acute angle closure (AAC), primary angle closure suspect (PACS) eyes, and normal eyes; and to identify eyes at high risk of AAC among primary angle closure suspects. Methods: In this case-control study, 16 unaffected fellow eyes of patients with a previous attack of AAC (group I), 20 PACS eyes (group II) and 18 normal eyes (group III) underwent Pentacam and A-scan echography. Results: Mean anterior chamber volume was 72±18, 77±18 and 176±44 μl in groups I, II, and III, respectively (P<0.001). Corresponding values for anterior chamber angle in the same order were 24.8±4.6, 22.6±6.3 and 35.8±6.9 degrees (P<0.001), and that for anterior chamber depth measured from the corneal endothelium were 1.80±0.26, 1.93±0.23 and 3.13±0.59 mm, respectively (P<0.001). Using receiver operating characteristic (ROC) curves, anterior chamber volume ≤100 μl was associated with a high risk of AAC with sensitivity of 93.3% and specificity of 100%. Corresponding values for anterior chamber depth ≤2.1 mm were 86.7% and 100%, and that for anterior chamber angle ≤26o were 73.3% and 88.2%, respectively. Age, sex, central corneal thickness, and lens thickness were comparable among the study groups (all P values >0.05). Conclusion: Eyes with anterior chamber volume ≤100 μl, depth ≤2.1 mm and angle ≤26o may be considered at high risk for developing AAC. These criteria could be helpful for making decisions regarding prophylactic laser peripheral iridotomy. [ABSTRACT FROM AUTHOR]

Purpose: To compare the accuracy of noncycloplegic photorefraction (NCP) with that of cycloplegic refraction (CR) for detecting refractive amblyopia risk factors (RARFs) and to determine cutoff points. Methods: In this diagnostic test study, right eyes of 185 children (aged 1 to 14 years) first underwent NCP using the PlusoptiX SO4 photoscreener followed by CR. Based on CR results, hyperopia (≥ +3.5 D), myopia (≥ -3 D), astigmatism (≥ 1.5 D), and anisometropia (≥ 1.5 D) were set as diagnostic criteria based on AAPOS guidelines. The difference in the detection of RARFs by the two methods was the main outcome measure. Results: RARFs were present in 57 (30.8%) and 52 (28.1%) of cases by CR and NCP, respectively, with an 89.7% agreement. In contrast to myopia and astigmatism, mean spherical power in hyperopic eyes was significantly different based on the two methods (P < 0.001), being higher with CR (+5.96 ±2.13 D) as compared to NCP (+2.37 ±1.36 D). Considering CR as the gold standard, specificities for NCP exceeded 93% and sensitivities were also acceptable (≥ 83%) for myopia and astigmatism. Nevertheless, sensitivity of NCP for detecting hyperopia was only 45.4%. Using a cutoff point of +1.87 D, instead of +3.5 D, for hyperopia, sensitivity of NCP was increased to 81.8% with specificity of 84%. Conclusion: NCP is a relatively accurate method for detecting RARFs in myopia and astigmatism. Using an alternative cutoff point in this study, NCP may be considered an acceptable device for detecting hyperopia as well. [ABSTRACT FROM AUTHOR]

Purpose: To compare the patterns of uveitis, emphasizing similarities and discrepancies, in the Middle East and Europe. Methods: Six articles reporting uveitis patterns from the Middle East including a total of 2,693 cases, and seven articles with a sum of 4,379 cases from Europe were analyzed and patterns in each region were defined and compared. Results: In both regions, uveitis was most commonly seen in the fourth decade of life with anterior uveitis being the most common anatomical form. Idiopathic cases accounted for the majority of anterior and intermediate uveitis; toxoplasmosis was the most frequent entity in posterior uveitis while Behcet's disease and idiopathic forms were the next most common causes in the Middle East and in Europe, respectively. Conclusion: Since patterns of uveitis differ in various geographic regions, discovering these patterns would be helpful for the diagnosis and treatment of this broad category of conditions. This necessitates applying a universal diagnostic classification system to enable accurate comparisons. [ABSTRACT FROM AUTHOR]

Purpose: To report orthoptic changes after photorefractive keratectomy (PRK). Methods: This interventional case series included 297 eyes of 150 patients scheduled for PRK. Complete ophthalmologic evaluations focusing on orthoptic examinations were performed before and 3 months after PRK. Results: Before PRK, 2 (1.3%) patients had esotropia which remained unchanged; 3 (2%) patients had far exotropia which improved after the procedure. Of 12 cases (8%) with initial exotropia at near, 3 (2%) cases became orthophoric, however 6 patients (4%) developed new near exotropia. A significant reduction in convergence and divergence amplitudes (P < 0.001) and a significant increase in near point of convergence (NPC) (P < 0.006) were noticed after PRK. A reduction ≥ 10 PD in convergence amplitude and ≥ 5 PD in divergence amplitude occurred in 10 and 5 patients, respectively. Four patients had initial NPC > 10 cm which remained unchanged after surgery. Out of 9 (6%) patients with baseline stereopsis > 60 seconds of arc, 2 (1.33%) showed an improvement in stereopsis following PRK. No patient developed diplopia postoperatively. Conclusion: Preexisting strabismus may improve or remain unchanged after PRK, and new deviations can develop following the procedure. A decrease in fusional amplitudes, an increase in NPC, and an improvement in stereopsis may also occur after PRK. Preoperative evaluation of orthoptic status for detection of baseline abnormalities and identification of susceptible patients seem advisable. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and safety of topical mitomycin-C (MMC) drops with that of subconjunctival 5-fluorouracil (5-FU) injections for management of early bleb failure after trabeculectomy or combined phacoemulsification and trabeculectomy with posterior chamber intraocular lens implantation (PT+PCIOL). Methods: In a randomized comparative study, 37 eyes of 37 patients with impending early bleb failure received MMC 0.02% eye drops for 2 or 4 weeks (19 eyes) or subconjunctival 5-FU injections, 5 mg per dose (18 eyes). Complete success was defined as 5 < IOP ≤ 18 mmHg without medications. Results: Baseline characteristics were comparable between the study groups. However, there were more cases of combined PT+PCIOL in the MMC group [11 (57.9%) eyes versus 3 (16.7%) eyes, P = 0.017]. Mean preoperative IOP was 20.5±8.85 mmHg in the MMC group and 25.82±11.35 mmHg in the 5-FU group (P = 0.129), which was decreased to 13.2±6.1 and 10.6±4.8 mmHg respectively after 12 months (P = 0.159). There was no significant difference between the study groups in terms of bleb extent (P = 0.170), height (P = 0.178) or vascularity (P = 0.366). At the end of the study, complete success was achieved in 13 eyes (68.4%) in the MMC group and 14 eyes (77.8%) in the 5-FU group (P = 0.714). The survival of success at 8 months (median follow-up) was 89.5% and 86.5% in the MMC and 5-FU groups respectively; the number of glaucoma medications (P = 0.707) and best-corrected visual acuity (P = 0.550) were also comparable. Complication rates were similar in the study groups (P = 0.140). Conclusion: Topical MMC 0.02% has comparable safety and efficacy to subconjunctival 5-FU injections for management of early bleb failure. Topical MMC 0.02% drops are more convenient and can be initiated first, while 5-FU injections may be reserved for eyes with an insufficient response to topical MMC. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the therapeutic effect of intravitreal triamcinolone (IVT) injection for recent branch retinal vein occlusion (BRVO). Methods: In a randomized controlled clinical trial, 30 phakic eyes with recent (less than 10 weeks' duration) BRVO were assigned to two groups. The treatment group (16 eyes) received 4 mg IVT and the control group (14 eyes) received subconjunctival sham injections. Changes in visual acuity (VA) were the main outcome measure. Results: VA and central macular thickness (CMT) changes were not significantly different between the study groups at any time point. Within group analysis showed significant VA improvement from baseline in the IVT group up to three months (P < 0.05); the amount of this change was -0.53 ± 0.46, .-0.37 ± 0.50, .-0.46 ± 0.50, and -0.29 ± 0.45 logMAR at 1, 2, 3, and 4 months, respectively. Corresponding VA improvements in the control group were -0.20 ± 0.37, -0.11 ± 0.46, -0.25 ± 0.58, and -0.05 ± 0.50 logMAR (all P values > 0.05). Significant reduction in CMT was noticed only in the treatment group (-172 ± 202 µm, P = 0.029) and at 4 months. Ocular hypertension occurred in 4 (25%) and 2 (14.3%) eyes in the IVT and control groups, respectively. Conclusion: A single IVT injection had a non-significant beneficial effect on VA and CMT in acute BRVO as compared to the natural history of the condition. The 3-month deferred treatment protocol advocated by the Branch Vein Occlusion Study Group may be a safer option than IVT injection considering its potential side effects. [ABSTRACT FROM AUTHOR]

Purpose: To compare spherical aberration and contrast sensitivity function following implantation of four different foldable posterior chamber intraocular lenses (IOLs), namely Sensar, Akreos AO, Tecnis, and AcrySof IQ. Methods: In this randomized clinical trial, 68 eyes of 68 patients with senile cataracts underwent phacoemulsification and IOL implantation with Sensar (n=17), Akreos AO (n=17), Tecnis (n=17), or AcrySof IQ (n=17). Uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), spherical aberration and contrast sensitivity function (CSF) were compared among the study groups, 3 months after surgery. Results: There was no significant difference between the study groups in terms of age (P = 0.21). Mean postoperative BSCVA with Sensar, Akreos AO, Tecnis, and AcrySof IQ was 0.15±0.10, 0.12±0.9, 0.08±0.08, and 0.08±0.07 logMAR, respectively (P=0.08). Spherical aberration measured over a 4 mm pupil was significantly higher with Sensar and Akreos AO than the two other IOLs. The difference between Tecnis and AcrySof IQ was significantly in favor of the former IOL. Over a 6 mm pupil, spherical aberrations were comparable with Sensar and Akreos AO, furthermore spherical aberration was also comparable among eyes implanted with Akreos AO, AcrySof IQ, and Tecnis. Sensar yielded significantly inferior results as compared to Acrysof IQ and Tecnis. CSF with Sensar was inferior to the three aspheric IOLs at the majority of spatial frequencies. Tecnis yielded significantly better mesopic CSF at 1.5 and 3 cycles per degree spatial frequencies. Conclusion: Tecnis and AcrySof IQ provided significantly better visual function as compared to Sensar and Akreos AO, especially with smaller pupil size. However, this difference diminished with increasing pupil size. [ABSTRACT FROM AUTHOR]

Purpose: To report the anatomical and functional outcomes of surgery for retinal detachment associated with chorioretinal colobomas. Methods: In this retrospective interventional case series, 28 eyes of 28 patients (including 18 male subjects) who had undergone surgery for retinal detachment associated with chorioretinal colobomas were evaluated regarding the type of intervention, final visual acuity and anatomical outcomes, as well as complications. Cases with less than 3 months of follow-up were excluded. Results: Primary surgery included vitrectomy in 25 (89.3%) and scleral buckling in 3 (10.7%) eyes. The internal tamponade used in eyes undergoing vitrectomy was silicone oil in 23 (92%) eyes and 20% sulfur hexafluoride (SF6) in 2 (8%) eyes. Silicone oil was removed in 11 eyes (45.8%). The mean number of operations per eye was 1.57±0.74, mean follow-up was 40±36 months, and the retina remained attached in 26 eyes (92.9%) at final follow-up. Mean preoperative visual acuity was 2.33±0.55 (range, 1.15-2.9) logMAR which significantly improved to 1.72±0.9 (range, 0.09-3.1) logMAR postoperatively (P < 0.001), however, final median visual acuity was counting fingers at 2 m. The most common complications were cataracts (100%) and ocular hypertension (46.4%). Conclusion: The most prevalent surgical procedure for treatment of retinal detachment associated with chorioretinal coloboma was pars plana vitrectomy and the most frequently used tamponade was silicone oil. Although anatomical success was satisfactory, functional outcomes were not encouraging which reflects the complexity of the condition and associated abnormalities. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for management of refractory diffuse diabetic macular edema (DME). Methods: In this prospective interventional case series, eyes with refractory diffuse DME unresponsive to macular photocoagulation and/or intravitreal bevacizumab, and best corrected visual acuity (BCVA) =20/200 and =20/60 underwent triamcinoloneassisted PPV with ILM peeling. Pre- and postoperative evaluations included a complete ophthalmologic examination, fluorescein angiography and optical coherence tomography (OCT). Main outcome measures were BCVA and central macular thickness (CMT). Results: Twelve eyes of 12 patients with mean age of 59.6±3.9 (range, 55-68) years were operated and followed for a mean period of 4.9±1.0 (range, 4-6) months. Mean BCVA at final examination was 0.82 ± 0.18 logMAR which was not significantly better than its preoperative value of 1.00 ± 0.80 logMAR (P=0.959). Visual acuity improved by at least 2 lines in 3 eyes (25%), remained stable in 7 eyes (58%) and decreased by at least 2 lines in 2 eyes (17%). Mean CMT at final examination was 315±95 μm, which was significantly less than its preoperative value of 467±107 μm (P=0.004). Complications included vitreous hemorrhage in 2 and cataract progression in 5 eyes. Conclusion: PPV with ILM peeling for refractory diffuse DME seems to reduce macular thickness, but does not significantly improve visual acuity as observed after an intermediate-term follow up of about 6 months. [ABSTRACT FROM AUTHOR]

Purpose: To report the long-term results of intravitreal bevacizumab (Avastin) therapy for choroidal neovascularization (CNV) secondary to non-age-related macular degeneration (non-AMD). Methods: This prospective interventional case series was conducted on patients with non-AMD CNV. All patients received 1.25 mg intravitreal bevacizumab and were followed for at least 18 weeks. Indications for retreatment were decreased visual acuity or recurrence of subretinal fluid or hemorrhage associated with leakage on fluorescein angiography. Primary outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT). Secondary outcome measures consisted of any adverse event related to the therapy. Results: The study included 31 eyes of 28 patients with non-AMD CNV including idiopathic (n=11), due to myopia (n=7), angioid streaks (n=5), and other disorders (n=8). Mean initial BCVA was 20/100 which improved to 20/60 at 6 weeks; 20/40 at 12, 18, 24, and 36 weeks; and 20/30 at 54 weeks. Serial optical coherence tomography measurements showed mean CMT of 288 μm at baseline, which was decreased to 209 μm at last visit (P=0.95). There was no correlation between the underlying disease and changes in BCVA during the follow-up period. Conclusion: Intravitreal bevacizumab significantly improved visual acuity in eyes with non-AMD CNV due to various etiologies. [ABSTRACT FROM AUTHOR]