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Fariba Ghassemi, 1–3 Shahab Sheibani, 4 Mojtaba Arjmand, 3 Hosein Poorbaygi, 4 Emad Kouhestani, 1 Siamak Sabour, 5 Farhad Samiei, 6 Akbar Beiki-Ardakani, 7 Mahmood Jabarvand, 1 Ali Sadeghi Tari 1 1Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR, Iran; 2Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR, Iran; 3Ocular Oncology Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR, Iran; 4Radiation Application Research School, Nuclear Science and Technology Research Institute, Tehran, Iran; 5Safety Promotion and Injury Prevention Research Centre, Department of Clinical Epidemiology, School of Health,Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran; 6Radiation Oncology Department, Cancer Institute, Imam Hospital and Medical Complex, Tehran University of Medical Sciences, Tehran, Iran; 7Radiation Physics Department, Princess Margaret Hospital, Toronto, ON, CanadaCorrespondence: Fariba GhassemiEye Research Center, Farabi Eye Hospital, Qazvin Square, Tehran 1336616351, IranTel +98-21-55421006Fax +98-21-55416134Email fariba.ghassemi@gmail.comBackground: To compare iodine-125 ( 125I) with ruthenium-106 ( 106Ru) episcleral plaque radiation therapy in terms of the effectiveness and non-inferiority for choroidal melanoma treatment.Objective: To report the non-inferiority of new made iodine-125 ( 125I) compared with ruthenium-106 ( 106Ru) episcleral plaque radiation.Patients and Methods: A retrospective, non-randomized comparative case series. In this series the patients treated with 125I and 106Ru episcleral plaques for choroidal melanoma between September 2013 and August 2017 at Farabi Hospital are compared. Local control of choroidal melanomas after 125I and 106Ru plaques implantation and vision changes are the main outcome measures.Results: A total of 35 patients were identified ( 125I = 15, 106Ru = 20). No significant difference between two groups in visual acuity, diameter and thickness changes were observed after treatment. Multivariate linear regression (MLR) analysis showed that final diameter was only, independently and significantly, correlated with the pre-treatment diameter of the tumor (β =  0.59, 95% confidence interval [CI]: 0.29, 1.34, P =  0.003). The same MLR analysis for the final thickness and visual acuity, after adjusting for age and sex showed no significant difference between two groups. A single patient treated with 106Ru had local tumor recurrence with no one in the 125I group. No statistical difference in the rate of ocular complications was observed.Conclusion: The treatment with our 125I plaques is as effective as 106Ru plaques in controlling choroidal melanoma tumor and preserving the vision during the two and half year of follow-up. The complication rates are alike. It means that the effectiveness of 125I is not only comparable to 106Ru but also superior when the outcome of the interest is the thickness of the tumors.Keywords: brachytherapy, choroidal melanoma, complication, local tumor control, 125I, radiation, 106Ru, tumor size, vision preservation

Purpose: To determine the magnitude and causes of blindness and visual impairment (VI) in Kurdistan, using the Rapid Assessment of Avoidable Blindness methodology. Methods: In this population-based cross sectional study, 99 clusters were selected through probability proportional to size sampling. Visual acuity (VA) was measured using a standard tumbling “E” chart. Ophthalmologists examined participants with VA < 6/18 in both eyes. The cause of VI in the better eye or the most treatable cause was considered as the primary cause of VI. Results: A total of 3203 (response rate: 92.4%) individuals aged 50 years and older participated, of whom 1657 (51.7%) were female. The standardized prevalence of blindness, severe visual impairment (SVI), and moderate visual impairment (MVI) based on available correction (presenting VA) were 2.1% (1.5-2.6), 1.7% (1.2-2.2), and 9.6%(8.4-10.8), respectively. The proportion of avoidable causes of blindness, SVI, and MVI were 58.1%, 78.4%, and 83.4%, respectively. The most common cause of blindness and SVI was cataract (27.4% and 60.8% respectively), followed by age-related macular degeneration (25.8% and 13.7%, respectively). The leading causes of MVI were uncorrected refractive errors (RE) (37.2%) and cataract (33.6%). Conclusion: The prevalence of blindness in the study population seems comparable to the region. According to our results, blindness, SVI, and MVI were mostly due to avoidable causes. Cataract and refractive errors are the principal causes of blindness and VI in Kurdistan.

Developmental midline perinasal masses in children are rare lesions specifically in association with choristomas. We encountered a 3-year-old boy with epiphora, a striking mass on the nasal bridge and ipsilateral nasal hypoplasia. CT scan imaging showed multiple calcified areas within the tumor in addition to linear defect in frontal bone, hypoplastic left ethmoidal sinus and left nasal cavity, and absence of left nasal concha. The patient had no history of seizure, no neurologic deficit, and ocular developmental exams were normal. After performing excisional biopsy of the tumor, histopathologic analysis revealed complex choristoma composed of cartilage and bone. The most appropriate name for this malformation, which we have not found described in the literature, seems to be, nasal hypoplasia with complex choristoma and nasolacrimal duct obstruction.

Although uncommon, traumatic optic neuropathy (TON) is an important cause of visual loss. Different therapeutic approaches including different dosages of steroids, surgical decompression of optic canal and observation alone have been suggested but there has been no conclusive evidence to establish a standard approach to this devastating cause of visual loss. To determine the effectiveness of intravenous (IV) steroids in the treatment of these patients, the medical records of patients with TON, including one bilateral case, treated with IV steroids were reviewed. Twenty-eight patients (22 males, 6 females) with mean age of 24.1 (11 to 41 years) were enrolled. All patients had received 30 mg/kg loading dose of methylprednisolone succinate followed by 5.4 mg/kg/ hour for 48 hours. Visual acuity (VA) was improved by ≥ 1 line in 8 eyes (28.6%) immediately after treatment and in 10 eyes (37%) after 3 months; however, most of them (6 and 8, respectively) were in the range of initial VA of no light perception to hand motion. After adjustment for the baseline VA, these improvements in visual acuities were not considered significant. Neither different orbital fractures, nor various extraocular muscle palsies had any significant effect on the prognosis of ultimate VA. Regarding the natural course of TON, this investigation showed that IV megadose steroids had no clear benefit on the visual outcome of patients with TON.

Leiomyoma is a very rare intraocular tumor, which can occur in the iris, ciliary body and choroids. We report a case of choroidal leiomyoma in a 16-Years old women whose left eye was enucleated because of clinical suspicion for melanoma. Using conventional light microscopy tumor was interpreted as spindle cell tumor, most probably of neurogenic origin and after using immunohistochemical studies; smooth muscle origin of tumor was confirmed.

Purpose: To evaluate alterations in orbital color Doppler imaging (CDI) parameters and their correlation to disease activity and severity in patients with thyroid eye disease (TED). Methods: Seventy-six orbits of 45 TED patients and 40 orbits of 40 normal controls were enrolled in this cross-sectional study. According to clinical activity score (CAS), patients were categorized to active (CAS ≥ 3) or inactive disease (CAS < 3). Patients were also classified as having mild, moderate or severe disease. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) in ophthalmic artery and central retinal artery, and maximum and minimum velocity in superior ophthalmic vein and central retinal vein were determined in all subjects. Results: There was a significant difference in maximum velocity of superior ophthalmic vein and EDV and RI of ophthalmic artery between patients with TED and normal subjects. Superior ophthalmic vein maximum and minimum velocity and ophthalmic artery RI were significantly higher in patients with active disease than inactive cases. Disease severity did not affect the blood flow parameters independently. A cutoff point of 3.99 cm/s in superior ophthalmic vein maximum velocity yielded a sensitivity of 91.2% and specificity of 81.2% in detecting active disease. Conclusion: Retrobulbar blood flow is altered in TED and is related to disease activity. Superior ophthalmic vein maximum velocity could be helpful in differentiation of active and inactive cases. [ABSTRACT FROM AUTHOR]

Purpose: To measure alterations in orbital blood flow parameters using color Doppler imaging (CDI) before and after orbital decompression in patients with moderate to severe thyroid eye disease (TED). Methods: Resistance index (RI) and maximum and minimum velocity of ophthalmic artery (OA), superior ophthalmic vein (SOV), and central retinal artery (CRA) of 24 eyes (14 patients) with TED were measured before and at least 3 months after cosmetic orbital decompression procedure (single or double walls) using CDI. Complete eye examination was performed to define the severity (EUGOGO classification) and activity (clinical activity score) of TED. Results: Median OA (p = 0.003) and CRA (p = 0.001) resistance indices were significantly reduced postoperatively. Significant differences were found in maximum (p = 0.001) and minimum (p = 0.014) velocity of SOV before and after surgery. While a significant decrease in exophthalmometry was observed after the orbital decompression (p = 0.031), intraocular pressure changes were not significant (p = 0.182). Conclusion: Orbital decompression procedure led to a significant reduction of RI in both CRA and OA in patients with TED. [ABSTRACT FROM AUTHOR]

Purpose: The disability‑adjusted life‑years (DALYs) lost due to eye diseases and trends in DALYs in Iran has not been previously reported. The object of this study is to report the burden of eye diseases in Iran and to compare changes from 1990 to 2010 based on age and gender. Methods: Data from the Global Burden of Disease Study 2010 (GBD 2010) are used to report DALYs for cataract, refraction/accommodation (functional) disorders, macular degeneration, and glaucoma. Results: Cataract, refraction/accommodation (functional) disorders, macular degeneration, and glaucoma were the 84th, 87th, 138th, and 151st causes of DALY in 1990 and the 89th, 72nd, 99th, and 137th in 2010, respectively. Cataract accounted for 0.085% of national DALY in 1990 and 0.09% in 2010, refraction/accommodation (functional) disorders accounted for 0.42% in 1990 and 0.47% in 2010, macular degeneration accounted for 0.017% in 1990 and 0.071% in 2010 and glaucoma accounted for 0.0099% in 1990 and 0.025% in 2010. There was a steady increase in DALY with age for each eye disease for both genders and dichotomized for males and females from 1990 to 2010. Conclusions: Epidemiologic transition is reflected in major ophthalmic and blinding diseases in the GBD data for Iran. The burden of macular degeneration is rising, followed by glaucoma. The burden of presbyopia affected individuals past their middle age. The burden of cataract manifested as a slower increase that could be attributable to better access to treatment. [ABSTRACT FROM AUTHOR]

Background: At the present time, only visual analysis is implemented on dacryoscintigraphic images and quantitative assessments are not routinely obtained. The authors have designed a novel, simple, quantitative method for the diagnosis of sac and post-sac obstructions based on the dacryoscintigraphic images. Method: Fifty-nine patients with severe unilateral epiphora were included and the contralateral asymptomatic eyes were used as controls. After ocular instillation of 0.1 cc isotonic saline containing 4 MBq 99mTcO4, dynamic images were obtained for 20 minutes. Visual interpretation was done by two blinded specialists in nuclear medicine. A Time-Activity Curve (TAC) was generated for each eye and its pattern was divided to plateau type, shallow-down sloping and deep-down sloping. The excretion ratio (expressed as the percentage of drained activity) in the 2nd, 3rd, 5th, 7th, 10th, 15th and 20th minute of the study was calculated based on the following formula: (the total count in the region of interest (ROI) in the 1st minute - the total ROI count in the 2nd, 3rd, 5th, 7th, 10th, 15th or 20th minute/the total ROI count in the 1st minute) × 100. The results of the quantitative analysis were compared with the clinical symptoms, visual analysis and TAC pattern. Results: At the optimal cut-off points for the 2nd, 3rd, 5th and 7th minute, the sensitivity of the prediction of obstruction was 76%, 72%, 71% and 69%, respectively. The correlation between visual interpretation and the TAC pattern was statistically significant. Conclusion: The quantitative evaluation of dacryoscintigraphic images would contribute greatly to achieving an easier and more objective interpretation of the scintigraphic results and also provides a reliable tool for inter-individual comparison and the follow-up of patients. As it is the first time that this innovative method has been examined clinically, it will be necessary to investigate its clinical utility in a larger series of patients. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the effect of smoking on retrobulbar blood flow parameters by color Doppler imaging in patients with thyroid eye disease.Patients and methodsIn this observational case series, blood flow parameters in the ophthalmic artery, superior ophthalmic vein, central retinal artery, and vein were determined by color Doppler imaging in patients with thyroid eye disease. Patients were grouped as smokers and non-smokers. Never smokers and those who had stopped smoking for at least 1 year before onset of ophthalmopathy were considered as non-smokers. A thorough ophthalmic examination including Hertel exophthalmometry was performed. Orbital CT scan was also carried out in all patients.ResultsFifty-one orbits from 30 patients between 21 and 62 years old (mean±SD: 40.8±12.0) were enrolled in this study. Smokers had greater proptosis and more active and sever disease. (P<0.05) Muscle involvement based on CT scan did not vary in smokers and non-smokers. Maximum velocity (3.78±1.74 vs 5.27±2.14, P<0.001; t-test) and minimum velocity (1.74±0.78 vs 3.26±1.36, P =0.014; t-test) in superior ophthalmic vein were significantly lower in smokers than non-smokers. Even after adjusting for age, sex, and clinical activity score and severity, smokers had a lower minimum velocity in superior ophthalmic vein (P =0.01; ANCOVA analysis).ConclusionCigarette smoking may correlate with increase in orbital venous congestion in thyroid eye disease.

Purpose: The aim of this study was to evaluate movement disorder patterns and extraocular muscle involvement in Iranian Graves' Ophthalmopathy (GO) patients., Methods: We examined 75 patients (37 women and 38 men) with GO. Female to male ratio was 0.97 among all patients and 0.72 among restrictive myopathic cases (male 18(58.1%), female 13 (41.9%), P=0.2). Their age ranged from 16 to 66 years; mean age was 35.42+/-11.63 and 33.55+/-10,.31 among patients affected by restrictive enlargement and who did not, respectively., Results: Orbital CT assessment showed EOM enlargement in 124 out of 150 orbits (82.6%). clinical restriction was evident in 31 (41.3%) out of 75 patients. Bilateral restriction was observed in 14 out of 31 (45.1%). The most frequent type of movement limitation was supraduction limitation followed by abduction, inferaduction, and adduction limitations (59%, 40%, 31.1% and 13.3% respectively). This was compatible with Hess screen results and orbital CT reports in regard of IR, MR, SR and LR involvement. Sixteen out of 75 patients reported diplopia. Mean Hertel exophthalmometry readings were higher in eyes with restrictive myopathy., Conclusion: This study showed more restrictive myopathy in cases with more extraocular enlargement and positive correlation between severity of inferior rectus enlargement and Hertel reading. A higher rate of male patients in our study may be due to ethnic differences in GO in Iranian patients or due to severity of involvement in this group.