Search

Purpose: To evaluate the effects of onion juice on sodium-selenite induced cataract formation. Materials and Methods: Thirty-two 10-day-old Wistar-albino rat pups were divided into four equal groups. Group 1 received only subcutaneous saline injection. In Group 2, sodium-selenite (30 nmol / g body weight) was injected subcutaneously. In Group 3, subcutaneous sodium-selenite was injected and one drop 50% diluted fresh juice of crude onion was instilled every 8 h into the right eye for 14 days; the left eye received no treatment. Group 4 rats were similar to those of Group 3, the only difference being that of undiluted fresh juice of crude onion. The development of cataract was assessed. Rat lenses were analyzed for total antioxidant (TA) level, and for activities of glutathione peroxidase (GPX) and superoxide dismutase (SOD). Results: Both eyes of all rats in Group 1 did not exhibit cataract formation . In Group 2, all rats developed Grade 3 cataract in the lenses of both eyes. The difference in exhibited cataract in the lens of the right eyes in all rats between Group 2 and any eyes of groups 3 or 4 were significant ( P = 0.001). The mean TA level and mean activities of SOD and GPX in Group 2 rat lenses were significantly lower than the values in lenses of all rats in Group 1 ( P = 0.001, 0.003, 0.001), and in the lenses of the right eyes of rats in Groups 3 and 4 ( P = 0.001, 0.020, 0.001). Conclusion: Instillation of onion juice into the rat eyes can effectively prevent selenite-induced cataract formation. This effect was associated with increased TA level, SOD and GPX activities in the lens.

Abstract Introduction The surgical correction of anomalous movement such as upshoot in Duane syndrome is challenging. Lateral rectus muscle disinsertion and reattachment to the lateral orbital wall is a new approach used to minimize or eliminate the effects of co-contraction including globe retraction, palpebral fissure narrowing and anomalous vertical movement. Case presentation We report a case of a 7-year-old boy who underwent this procedure for severe upshoot, globe retraction and exotropia in the left eye due to Duane syndrome. The patient achieved satisfactory ocular alignment following surgery. Upshoot and globe retraction were substantially improved. Conclusion Lateral rectus muscle disinsertion and reattachment to the lateral orbital wall is a safe and effective procedure for weakening of the anomalous lateral rectus muscle in Exotropic Duane Syndrome.

Abstract Background Gyrate atrophy of the retina and choroid is a rare autosomal recessive inherited disease, characterized by progressive chorioretinal atrophy that results in progressive deterioration of peripheral and night vision and leading to blindness. Case presentation This report presents a case of a 28-year-old man consulting for a progressive fall of visual acuity with hemeralopia. Eye fundoscopy showed regions of confluent rounded chorioretinal atrophy. The visual field and retinal angiography were altered. A high level of plasma ornithine (629 nmol/mL) was detected and a diagnosis of gyrate atrophy of the retina and choroid was made. The patient was treated with high dose Pyridoxine supplement (300 mg/d for 6 months) and the ornithine level of his serum was successfully reduced. Conclusion The exact mechanism of chorioretinal atrophy in hyper-ornithinemia is not known and a small percentage of the affected people respond to Vitamin B6 supplementation.

Abstract Background To investigate the efficacy of posterior subtenon methylprednisolone acetate injection in treatment of refractory diffuse clinically significant diabetic macular edema (CSME). Methods In a prospective, nonrandomized, interventional case series, 52 eyes were diagnosed with CSME and treated with at least two sessions of laser photocoagulation according to Early Treatment Diabetic Retinopathy Study guidelines. At least 3 months after laser therapy, eyes with a residual central macular thickness were offered posterior subtenon injection of 40 mg methylprednisolone acetate. Main outcome measures were visual acuity, macular thickness and intraocular pressure. Potential complications were monitored, including intraocular pressure response, cataract progression and scleral perforation. Results Mean baseline visual acuity (in logMAR) improved significantly (p = 0.003) from 0.8 ± 0.36 to 0.6 ± 0.41 at 3 months. Mean foveal thickness decreased from 388 ± 78 μm at baseline to 231 ± 40 μm after 3 months (p < 0.0001). Visual acuity improvement in eyes with CSME with extrafoveal hard exudates was significant (p = 0.0001), but not significant in eyes with CSME with subfoveal hard exudates (p = 0.32). Intraocular pressure increased from 14.7 ± 2.0 mmHg (range, 12–18 mmHg) to a maximum value of 15.9 ± 2.1 mmHg (range, 12–20 mmHg) during the follow-up period. Complications in two eyes developed focal conjunctival necrosis at the site of injection. Conclusion Posterior subtenon methylprednisolone acetate may improve early visual outcome in diffuse diabetic macular edema that fails to respond to conventional laser photocoagulation. Visual acuity improvement in eyes with CSME with extrafoveal hard exudates was significant; and this improvement is depends on location of hard exudates. Further study is needed to assess the long-term efficacy, safety, and retreatment.

Background: Age related macular degeneration (AMD) is the leading cause of irreversible blindness in the elderly population. Inflammatory mediators play an important role in AMD pathogenesis and immune-related gene polymorphisms are shown to increase the risk. Complement system is an important mediator of the immunity system and several genes encoding proteins involved in this system are associated with susceptibility to AMD. The central element of the complement cascade, C3 has been a plausible candidate since its cleavage product C3a was found in drusen. This study was planned to evaluate the association of C3-rs2230199 (R102G) variants with advanced type AMD in this cohort. Materials and methods: In this case-control study, 494 participants consisting of 266 AMD patients (187 wet AMD and 79 advanced dry AMD) and 228 samples from unrelated healthy controls were enrolled for evaluation. Extracted-DNA samples were amplified to obtain fragments including the polymorphic region. Results: The distribution of the R102G genotypes was significantly different in the AMD patients compared to controls (p= 0.001).The Odds Ratio compared to CC individuals was 1.69 (95% CI 1.15–2.49) for GC individuals and 6.48 (95% CI1.87–22.43) for GG individuals. The Odds Ratio compared to the C allele was 2.31 (95% CI 0.48–11) for the G allele. GG and GC genotypes and G allele were significantly associated with both types of advanced-AMD. Individuals carrying GG genotype have over a six-fold risk of developing AMD in comparison to those carrying the CC genotype in this cohort. Our meta-analysis pooled data showed that our homozygous individuals for GG have a higher risk of AMD compared to previous publications in different nations (p= 0.017). Conclusions: Our study shows C3 to be a relatively strong susceptibility gene for advanced-type-AMD (exudative-and-geographic-atrophy) in an Iranian population. [ABSTRACT FROM PUBLISHER]

Introduction: Retinal capillary nonperfusion (CNP) is one of the retinal vascular diseases in diabetic retinopathy (DR) patients. As there is no comprehensive detection technique to recognize CNP areas, we proposed a different method for computing detection of ischemic retina, nonperfused (NP) regions, in fundus fluorescein angiogram (FFA) images. Methods: Whilst major vessels appear as ridges, nonperfused areas are usually observed as ponds that are surrounded by healthy capillaries in FFA images. A new technique using homomorphic filtering to correct light illumination and detect the ponds surrounded in healthy capillaries on FFA images was designed and applied on DR fundus images. These images were acquired from the diabetic patients who had referred to the Nikookari hospital and were diagnosed for diabetic retinopathy during one year. Our strategy was screening the whole image with a fixed window size, which is small enough to enclose areas with identified topographic characteristics. To discard false nominees, we also performed a thresholding operation on the screen and marked images. To validate its performance we applied our detection algorithm on 41 FFA diabetic retinopathy fundus images in which the CNP areas were manually delineated by three clinical experts. Results: Lesions were found as smooth regions with very high uniformity, low entropy, and small intensity variations in FFA images. The results of automated detection method were compared with manually marked CNP areas so achieved sensitivity of 81%, specificity of 78%, and accuracy of 91%.The result was present as a Receiver operating character (ROC) curve, which has an area under the curve (AUC) of 0.796 with 95% confidence intervals. Conclusion: This technique introduced a new automated detection algorithm to recognize nonperfusion lesions on FFA. This has potential to assist detecting and managing of ischemic retina and may be incorporated into automated grading diabetic retinopathy structures. [ABSTRACT FROM AUTHOR]

Background and Objectives: Wet type Age-related Macular Degeneration (Wet type AMD) is a debilitating ocular disease which generally occurs among elderly population. Tumor Necrosis Factor alpha (TNF- ) is a reactive phase protein which is associated with Alzheimer, atherosclerosis, type 2 diabetes mellitus and aging. Materials and Methods: In this case-control study, 40 eyes of 40 patients with wet type age-related macular degeneration and 49 normal eyes of 49 healthy people were randomly selected and serum levels of TNF- , lipid profile and fasting blood glucose were checked. Results: The difference of mean ages and male to female ratio were not statistically significant (P=0.441, P=0.091). Serum level of TNF- was significantly higher among patients with retinal degeneration (Median (IQR) = 0.2 (0.1-0.58) vs. 0.1 (0-0.2); P=0.002). Conclusion: TNF- would have a role in the pathogenesis of the wet type age-related macular degeneration and pharmaceutical and/or non-pharmaceutical interventions might decelerate or even cease the progression of this ominous disease. [ABSTRACT FROM AUTHOR]

Calcification and inflammation are among the important cases of exudative age-related macular degeneration (E-ARMD). The aim of the present study was to elucidate if there is any relationship between serum Osteoprotegerin (OPG), soluble receptor activator of nuclear factor-kappa B ligand (RANK-ligand) and E-ARMD. In a cross-sectional study, we compared 45 E-ARMD patients with 45 matched controls. Diagnosis was confirmed by fluorescein angiography. Serum samples were analyzed for OPG, RANK-ligand, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG). The levels of OPG and RANK-ligand were measured by ELISA methods. The mean age was 72.0±1 1.5 years in the E-ARMD group and 68.2±8.9 years in the control group (p=0.09). The level of serum OPG was 132.10±75.49 pg/ml in the E-ARMD group and 94.88±61.65 pg/ml in the control subjects. E-ARMD patients had significantly high levels of OPG (p=0.012), as well as significantly high levels of LDL-C and TC (p=0.001 and p=0.005, respectively). We could not find any significant difference in RANK-ligand, HDL-C, or TG between two study groups (p>0.05). To the best of our knowledge, this is the first study investigating the levels of OPG in E-ARMD patients. The present study showed that E-ARMD patients had high levels of serum OPG. It may act as a protective factor for E-ARMD or only as a secondary phenomenon of different processes of E-ARMD. Further prospective studies would be necessary for prognostic and predictive significance of OPG in patients affected by E-ARMD [ABSTRACT FROM AUTHOR]

Background and purpose: Retinal detachment is an ophthalmic problem in which subsequent complications could be avoided if diagnosed on time. This research aims at studying the prevalence of the causes of retinal detachment in the patients admitted to Tabriz Nikokari a hospital. Materials and methods: In a descriptive study, 300 patients with retinal detachment admitted to Tabriz Nikokari Hospital from 2007 to 2009 were studied. Demographic information, history of eye diseases, causes of retinal detachment and the types of treatments in all patients were recorded. Results: In this study, 300 patients with retinal detachment were enrolled including 207(69%) men and 93(31%) women with the mean age of 42.56 ± 17.1 years. In 52.7% of the patients the right eye was involved and 47.3% suffered from retinal detachment in the left eye. Only 27.3% of the patients had myopia and 37% of them had undergone a previous cataract surgery. Among patients, 28.7% had a history of eye trauma. There were significant differences between the two genders in myopia, diabetes and trauma (P< 0.05). Conclusion: The findings demonstrated that factors such as diabetes, patients' age, male gender, myopia and the previous cataract surgery existed in the history of the patients with retinal detachment. It is concluded that supplementary evaluations and intervention in the appropriate time can be helpful in decreasing the retinal detachment rate in these patients. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy accounts for a considerable amount of the blindness especially among the patients who are between 20 to 60 years. The early detection of this disease plays an important role in preventing vision damages and appropriate follow-up care of diabetic eye. Manual investigation of color fundus images to check morphological changes in dark and bright lesions is tedious work and very time-consuming that can be made easily with the help of computer-aided diagnosis system. Many techniques were proposed for early detection of the abnormalities in the retinal images help the ophthalmologists recognize the retinopathy earlier. This paper presents a review of various automated algorithms that have been used for the detection of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

Background and Objectives: Exudative Age Related Macular degeneration (E-ARMD) is a multifactorial disease. The aim of the present study was to investigate the plasma levels of asymmetric dimethylarginine (ADMA) as a factor involved in oxidative stress in patients with E-ARMD. Materials and Methods: In a case-control study, 45 patients with E-ARMD were compared with 45 sex- and age- matched healthy controls. The plasma levels of ADMA were measured by Enzyme-Linked ImmunoSorbant Assay (ELISA) method in both groups. Results: The levels of ADMA were higher in patients with E-ARMD (0.84±0.23 μM) than normal controls (0.71±0.25 μM) and the difference was statistically significant (p=0.012). Conclusion: High levels of ADMA as an endogenous nitric oxide synthase inhibitors may have a role in oxidative stress in E-ARMD patients. [ABSTRACT FROM AUTHOR]

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 benefits, 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 final 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., Competing Interests: There are no conflicts of interest.

Purpose: To determine the benefits of calcium dobesilate (CaD) administration on endothelial function and inflammatory status in patients with diabetic retinopathy through measurement of serum levels of endothelin-1 and high-sensitivity C-reactive protein (hsCRP)., Methods: In a double-blind, randomized clinical trial, 90 patients with either severe nonproliferative or proliferative diabetic retinopathy and with blood glucose level of 120-200 mg/dl were randomly allocated to treatment with either CaD tablets (500 mg daily) or placebo for 3 months. Visual acuity, intraocular pressure, and macular status were performed before the study. The serum levels of endothelin-1 and hsCRP were evaluated in both groups before and at the third month of the trial., Results: The median serum level of hsCRP significantly differed between the groups 3 months following the CaD or placebo administration (2.2 mg/l in the CaD group versus 3.7 mg/l in the placebo group, p=0.01). The mean endothelin-1 serum level was 0.69±0.32 pg/ml in the CaD group and 0.86±0.30 pg/ml in the placebo group (p=0.01). Furthermore, in the CaD group, the serum levels of both endothelin-1 and hsCRP were significantly decreased 3 months after administration of CaD (p<0.001)., Conclusions: Administration of the CaD in the patients with diabetic retinopathy may reduce the serum levels of endothelin-1 and hsCRP. This might imply amelioration of the endothelial function and inflammatory status following CaD therapy in these patients.

Purpose: The aim of this study was to evaluate the effect of Helicobacter pylori (H. pylori) treatment on remission of idiopathic central serous chorioretinopathy., Methods: Twenty-five patients with idiopathic central serous chorioretinopathy (ICSCR) who were infected with H. pylori were treated with an anti-H. pylori treatment; another twenty-five patients with the same clinical presentations served as the control. Baseline examination and follow up visits at 2, 4, 6, 8, 12, and 16 weeks after the onset of treatment included visual acuity testing and subretinal fluid measurement. The difference between mean visual acuity at the end of 16 weeks and the time of subretinal fluid reabsorption was compared between the two groups., Results: Subretinal fluid reabsorption time was 9.28±3.20 weeks in the treatment group and 11.63±3.18 weeks in the control group, which was statistically significant (p=0.015). After 16 weeks, mean visual acuity improved to 0.003±0.01 (logMAR) in the treatment group and 0.004±0.02 (logMAR) in the control group. This improvement did not represent a statistically significant difference (p=0.97)., Conclusions: An anti-H. pylori treatment regimen is effective in the treatment of idiopathic central serous chorioretinopathy patients and anti-H. pylori treatment can provoke the faster reabsorption of subretinal fluid.

Purpose: To evaluate DNA damage markers and the antioxidant status of serum and aqueous humor in glaucoma patients., Methods: Aqueous humor and serum samples were obtained at the time of surgery from 28 patients with glaucoma and 27 patients with cataracts. Total antioxidant status (TAS) and 8-hydroxy-2´-deoxyguanosine (8-OHdG) levels of all samples were determined by spectrophotometric and enzyme-linked immunosorbent assay methods., Results: Aqueous levels of 8-OHdG were higher in glaucoma patients than in the cataract group (4.61±2.97 ng/ml versus 1.98±0.70 ng/ml, p=0.002). Serum levels of 8-OHdG were also higher in glaucoma patients than in the cataract group (17.80±8.06 ng/ml versus 13.63±3.54 ng/ml, p=0.046). The TAS levels of serum (0.55±0.13 mmol/lit versus 0.70±0.14, p=0.001), and aqueous humor (0.23±0.13 mmol/lit versus 0.34±0.15, p=0.001) in glaucoma patients were lower than in cataract patients., Conclusions: Our findings provide evidence that oxidative DNA damage increases and TAS decreases in the serum and aqueous humor of glaucoma patients. These findings support the hypothesis that the formation of reactive oxygen species and/or a decrease in TAS may have an important role in the pathogenesis of glaucoma.

Purpose: It was proposed that total thiols (tSH) as powerful reducing agents and oxidized low-density lipoprotein (OX-LDL) may be associated with development of choroidal neovascularization in exudative age-related macular degeneration (E-ARMD)., Methods: In a case-control study, 45 patients with E-ARMD were compared with 45 sex- and age-matched healthy controls. The levels of plasma homocysteine (Hcy) and OX-LDL as oxidant agents, and of tSH and glutathione (GSH) as antioxidant markers, were estimated in E-ARMD patients and controls., Results: The levels of Hcy (15.4±7.2 μM versus 10.7±3.7 μM; p=0.001) and OX-LDL (52.2±13.8 U/l versus 37.8±10.8 U/l; p=0.001) were statistically higher, while GSH (1.10±0.97 μM versus 2.09±1.04 μM; p=0.001) and tSH (0.31±0.06 mM versus 0.35±0.05 mM; p=0.001) were statistically lower, in the patients with E-ARMD than in the control group, respectively. The plasma OX-LDL concentration also exhibited a positive and significant correlation with Hcy (r=0.719, p=0.001) in patients with E-ARMD., Conclusions: Lower GSH and tSH as antioxidant and higher Hcy levels as oxidant agents in E-ARMD patients may have resulted in an oxidative environment that was associated with OX-LDL. Further studies with more cases are required to confirm the hypothesis.

Purpose: This study was designed to evaluate the levels of Interleukin-6 (IL6) and Hepcidin prohormone (Hep) in the serum and aqueous humor of patients with primary open-angle glaucoma (POAG), as well as those with senile cataract as a control group., Methods: Levels of IL6 and Hep were measured by enzyme-linked immunosorbent assay (ELISA) methods in serum and aqueous humor aspirates taken from 45 patients (POAG=20, Control=25) during anterior segment surgery., Results: The mean aqueous humor Hep concentration in eyes with POAG was significantly higher than that controls (34.55±23.01 ng/ml versus 20.82± 24.63 ng/ml, p=0.04). There was no significant difference between the serum Hep concentration of POAG and the control group (359.46±113.03 ng/ml versus 287.36±130.53 ng/ml, p=0.08). There was also no significant difference between either serum (6.18±5.22 versus 10.84±3.37, pg/ml p=0.112) or aqueous humor (4.39±3.06 versus 5.79±2.63, pg/ml p=0.14) IL6 concentrations of POAG and the control groups. No significant correlations were found between aqueous humor and serum Hep and IL6 levels in either POAG or the control groups (p>0.05)., Conclusions: The aqueous humor Hep level may exist locally and independent from the IL6 increase in patients with POAG, suggesting that Hep might represent a bridge protein between local inflammation and the consequent loss of retinal ganglion cells.

Purpose: Elevated levels of lipoprotein(a) [Lp(a)] and homocysteine (Hcy) have been implicated as risk factors for vascular diseases. The study was performed to explore the possible relationship between retinal arteriosclerosis and serum Lp(a) and Hcy levels., Methods: Study subjects consisted of 80 nonsmoking male patients with retinal arteriosclerosis and 54 healthy nonsmoker males as controls. Retinal arteriosclerosis was graded according to the Scheie classification. Serum levels of lipids, lipoproteins, Lp(a), and Hcy were measured by standard methods., Results: The serum level of Hcy was higher in patients (24.2+/-8.1 micromol/l) than controls (10.5+/-4.1 micromol/l); p<0.01. Serum levels of Lp(a) in patients (47.9+/-33.1 mg/dl) was also higher than controls (11.7+/-7.6 mg/dl); p<0.01. There was a significant direct linear correlation between the degree of retinal arteriosclerosis and Lp(a) level (r=0.61, p<0.01), the degree of retinal arteriosclerosis and Hcy level (r=0.72, p<0.01), and also between Lp(a) and Hcy levels (r=0.67, p<0.01)., Conclusions: The association between retinal arteriosclerosis and serum Lp(a) and Hcy levels suggests that Lp(a) as well as Hcy could play a role in the development of retinal arteriosclerosis.

Objective: To determine the susceptibility of low-density lipoprotein (LDL) to oxidation in the plasma of male patients with wet type age related macular degeneration (AMD) and in a similar control group, in order to evaluate the LDL oxidative status as risk factor of AMD., Methods: We conducted this study in the Retina Service, Department of Ophthalmology, Nikookari Eye Hospital-Drug of Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran during the period between October 2004 and December 2005. Sixty male patients with AMD (mean age 67 +/- 16 years) with BMI 4.1 +/- 1.3 were selected as the patient group. The control group consisted of 60 males, apparently healthy, and without ophthalmologic signs and family history of AMD. Low-density lipoprotein was isolated by gradient ultracentrifugation and susceptibility of LDL to in vitro copper-mediated oxidation was assayed by measuring conjugated dienes production (lag phase duration) at 234 nm. Lipid and lipoproteins were determined by standard methods., Results: Comparing with control, significant reduction in the duration of lag phase (p<0.004) and a significant increase in LDL-C concentrations (p=0.006), were noticed. No significant change in cholesterol (p>0.3), triglyceride (p>0.1) and high density lipoprotein cholesterol (p>0.1) levels were found between control and patient groups. A significant negative correlation between Lag phase and LDL-C levels (p=0.004, r=-0.364) was found in the patient group., Conclusion: The increased LDL concentration and enhanced susceptibility of LDL to oxidation may play a roll in the wet type AMD process.