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To describe the findings and new interpretation methods of retinal thickness maps in the setting of hydroxychloroquine (HCQ) therapy.A case series of 27 patients with a history of HCQ intake of more than 5 years and 21 normal subjects as the control group were studied. Patients were tested using swept-source optical coherence tomography (OCT). Custom-made 10 × 10 retinal thickness pixel maps of the 6 mm⨯6 mm area centered on the fovea were created for the full, inner, and outer retina of each eye and normal values obtained from the control group were used to calculate the statistical significance of each pixel and highlight suspicious pixels. A pixel was shown with light or dark gray color if its p value was ≤ 0.05 or ≤ 0.01, respectively. Cross-sectional OCT images and visual fields were examined as well and used to confirm the diagnosis of HCQ retinopathy.The pixel outer retinal thickness maps appeared accurate in detecting lesions even in eyes with unremarkable full retina thickness maps. The size and location of atrophic retinal defects were shown on pixel maps. Outer retinal thickness maps were able in differentiating outer retinal thinning from inner retinal thinning as the hallmark of HCQ retinopathy.Outer retinal thickness pixel maps can be used for the screening of HCQ retinopathy.

Purpose To investigate the effect of intravitreal recombinant tissue plasminogen activator (rt-PA) injection before vitrectomy on surgical facility and outcome in diabetic tractional retinal detachments (TRD). Methods Prospective, randomized, interventional clinical trial. A total of 38 eyes with diabetic TRD were candidates for vitrectomy. Patients were randomized 1:1 to receive intravitreal rt-PA, five to seven days before vitrectomy or no injection. Intraoperative surgical facility and anatomic success at month 3 after surgery were assessed. Results Mean patient age was 54.2 ± 9.4 years. There was no statistically significant difference between rt-PA and no injection groups with regard to anatomic success (89% versus 95%, respectively, P = 0.547) and best corrected visual acuity at 3 months (2.0 versus 2.1 logMAR, respectively, P = 0.840). However, surgical facility score was statistically significantly lower in rt-PA injection group compared to no injection group (4.1 ± 1.7, 5.8 ± 2.0, respectively, P = 0.007). Conclusions Vitrectomy for TRD was easier after preoperative rt-PA injection, without affecting the anatomic and visual outcomes.

Purpose: To evaluate the role of intrasilicone oil injection of methotrexate (MTX) at the end of vitrectomy surgery for rhegmatogenous retinal detachment (RRD) associated with proliferative vitreor...

Purpose To measure the foveal avascular zone (FAZ) areas and vessel densities of patients with diabetic retinopathy and to study their relationship with diabetic cystoid changes and retinal thickness. Methods Prospective case series of 51 eyes of 31 patients with diabetic retinopathy. The eyes were grouped based on the presence or absence of cystoid edema and evaluated using optical coherence tomography angiography. The FAZ areas and vessel density were compared. Results The FAZ area at the superficial capillary plexus level was equal between the eyes with and without cystoid edema. Vessel density did not differ as well. There was no correlation with retinal thickness. In eyes with cystoid changes, FAZ area changes at the deep capillary plexus level were difficult to interpret. Conclusion The FAZ area and vessel density at the superficial capillary plexus level are reproducible and independent of the presence of cystoid edema.

Objective: To evaluate the short-term changes in Schirmer I test (ST) after pars plana vitrectomy and to compare the results between 23 gauge and 20 gauge vitrectomy surgeries. Methods: 42 patients who underwent pars plana vitrectomy for posterior segment diseases were included in this prospective, non-randomized, comparative study. The choice of sclerotomy gauge was at the surgeons’ discretion. ST values were recorded before and at 1 and 3 months after vitrectomy. Results: 20 patients in 23 gauge and 22 patients in 20-gauge group with a mean age of 59.9 ± 13.5 years were included. The mean preoperative ST values decreased significantly in both groups at 1 and 3 months after surgery (all P < 0.01). The ST values in the fellow eyes were the same, at baseline and during the follow up (P > 0.05). At 3 months visit, 15 eyes (35.7%) had abnormal ST measurements. There was no statistically significant difference in the changes in the ST measurements between the two groups at one month (P = 0.7), however, 3 months after surgery, the mean decrease in the ST measurements was significantly higher in the 20 gauge group (P = 0.03). At 3 months, 4 eyes in the 23 gauge group (20%) and 11 eyes in the 20 gauge group (50%) had abnormal ST measurements (P = 0.05). Conclusions: Although both 20 and 23-gauge vitrectomy decrease the ST measurements postoperatively, the value is less affected by the 23-gauge vitrectomy.

Granulocyte colony-stimulating factor (G-CSF) has potential ocular neuroprotective effects. The aim of this study was to evaluate the retinal toxicity of intravitreal G-CSF in rabbit eye.Eight New Zealand albino rabbits, weighing between 2 and 3 kg, were selected for this study. The initial concentration of G-CSF (300 µg/0.5 ml) was titrated to obtain different concentrations of 45 μg, 30 μg, 15 μg, and 7.5 μg in 0.1 ml. Each concentration was injected into two rabbit eyes. For each dose, dextrose was injected in one contralateral eye and the other fellow eye remained non-injected. Electroretinographic (ERG) testing was performed before and 4 weeks after injections. The rabbits were euthanized and the eyes were enucleated 4 weeks after injections and examined using light microscopy and immunohistochemistry.One rabbit with the injected dosage of 7.5 µg died at the first post-injection day. No sign of intraocular toxicity was found in clinical examination in other rabbits. A significant decrease in at least one of the a- or b-wave measurements of scotopic or photopic responses was found in 45 µg, 15 µg, and 7.5 µg injected eyes. Eyes with an intravitreal injection dosage of 30 µg G-CSF did not have significant changes compared to the baseline values. Histologic and immunohistochemistric studies were unremarkable for pathologic changes in all injected eyes.While histologic and immunohistochemistric examinations revealed no toxicity in all G-CSF-injected eyes, significant ERG changes were observed in all doses except for the dose of 30 µg/0.1 ml.

To report the efficacy of mycophenolate mofetil (MMF) as adjunctive therapy for the treatment of multiple sclerosis (MS)-associated uveitis.In this retrospective, interventional case series, patients with MS-associated uveitis who were treated by MMF as an adjunct therapy to systemic corticosteroid were studied. Patients' demographics, clinical course, response to treatment, and complications were assessed.A total of 30 eyes of 15 patients with a mean age of 34.5 ± 8.3 years were studied. In three patients (20%), onset of uveitis preceded the diagnosis of MS. The course of MS was relapsing-remitting in 11 patients (73.3%) and secondary progressive in four patients (26.7%). At 1 year after institution of MMF, all the patients were on oral prednisolone ≤ 7.5 mg/day, all eyes were quiet without macular edema, and 53.3% of eyes gained visual improvement. Supplemental periocular and intraocular injections were needed during the first 6 months after starting MMF therapy. The systemic adverse effects were transient and minor in severity.MMF had beneficial effects on vision and intraocular inflammation with an acceptable safety profile.

Comparison of eyes with non-center involving diabetic macular edema treated with topical timolol eye drops with an untreated control group showed a statistically significant greater reduction in macular thickness in treated eyes. Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is the standard of treatment in eyes with diabetic macular edema (DME). Despite widely established benefits of Anti-VEGF agents, concerns surrounding cost, safety, need for repeated injections, adherence, tachyphylaxis or resistance to treatment and invasive nature of the procedure have encouraged researchers to look for other novel therapies for DME.

Purpose: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. Methods: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. Results: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. Conclusion: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients.

To evaluate the outcome of scleral buckling surgery in patients with rhegmatogenous retinal detachment (RRD) with subretinal proliferation.In this retrospective study, a chart review of all patients with RRD associated with subretinal proliferation who were primarily treated with scleral buckling procedure, from April 2007 to April 2014, was undertaken. Main outcome measures were anatomical retinal reattachment and visual acuity.Forty-four eyes of 43 patients including 24 males and 19 females with a mean age of 26.5±13.1 years were evaluated. Immediately after the surgery, retina was reattached in all eyes. However, five eyes (11.3%) needed additional surgery for retinal redetachment. Single surgery anatomical success rate was 88.7%. Four eyes (9.1%), needed pars plana vitrectomy for the treatment of redetachment associated with proliferative vitreoretinopathy and scleral buckle revision surgery was successfully performed in the other eye. Best corrected visual acuity improved from 1.5±0.9 logMAR before surgery to 1.1±0.7 logMAR after surgery (P0.001). An improvement in BCVA of2 lines was found in 23 eyes (52.2%) and worsening of best corrected visual acuity of2 lines was observed in 2 eyes (4.5%).Scleral buckling surgery is highly successful in eyes with RRD associated with subretinal proliferation.

Purpose To determine the changes in serum levels of free vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1), and growth parameters in infants with retinopathy of prematurity (ROP) who received intravitreal injection of the bevacizumab (IVB). Methods A prospective interventional case series study, including 10 infants with Type 1 ROP was conducted. Using the enzyme-linked immunosorbent assay, serum levels of VEGF and IGF-1 were measured before, 1 month and 2 months after treatment with IVB in both eyes. Growth parameters, including weight, length, and head circumference and their Fenton's z-score, were also measured. Results Serum VEGF levels were suppressed 1 month after IVB (P = 0.007) and then increased between 1 and 2 months (P = 0.064). Z-scores of all growth parameters except weight z-score decreased in the 1st and 2nd months. Conclusion Serum VEGF levels showed a transient reduction after IVB which lasted at least 2 months. Growth velocity of premature infants may be affected by anti-VEGF therapy and should be followed with particular attention.

Purpose: To report the outcomes of pars plana vitrectomy (PPV) and intravitreal phacoemulsification in patients with dropped nuclei/nuclear fragments following complicated cataract surgery. Methods: In this retrospective case series, charts of patients who had undergone PPV and intravitreal phacoemulsification for removal of dislocated nuclei/lens fragments were reviewed. After standard PPV, a conventional phacoemulsification probe with an amputated sleeve was used for grasping and emulsifying the nucleus/nuclear fragments in mid/anterior vitreous cavity. Pre- and postoperative visual acuity, and intra- and postoperative complications were recorded. Results: A total of 22 patients with mean age of 71.1΁8.2 years were studied. Mean interval between complicated cataract surgery and PPV was 26.6΁36.5 (range: 0-120) days. Patients were followed for a mean of 105.5΁57.5 days. Preoperatively, best corrected visual acuity was 2.4΁0.6 logMAR which was improved to 1.4΁0.6 logMAR at final follow-up (P

To compare the safety and efficacy of intravitreal injections of 1.25 and 2.5 mg bevacizumab for treatment of choroidal neovascularization associated with age-related macular degeneration.In this prospective, randomized, comparative clinical trial, 86 patients with active choroidal neovascularization associated with age-related macular degeneration were studied. Baseline best-corrected visual acuity in the study eye was from 20/40 to 20/2000. Patients were randomly assigned to receive intravitreal injections of 2.5 (39 patients) or 1.25 mg (47 patients) of intravitreal bevacizumab. Best-corrected visual acuity measurement and clinical ocular examination were performed at 1 week, 1 month and then monthly for 5 months. Fluorescein angiography and optical coherence tomography were performed at 1 month and 3 months after each injection.The mean change in best-corrected visual acuity was -0.06 +/- 0.3 logMAR in 1.25 mg and -0.07 +/- 0.34 in 2.5 mg groups in 3 months (P = 0.9) and -0.06 +/- 0.27 logMAR in 1.25 mg and -0.09 +/- 0.28 in 2.5 mg groups in 5 months (P = 0.6). There was no significant difference in visual acuity between the two groups at any time point during the study. The mean change in foveal thickness was -49 +/- 36 micro in 1.25 mg and -65 +/- 31 micro in 2.5 mg group (P = 0.6). In 2.5 mg group, three cases of vitreous reaction and one case of massive subretinal hemorrhage were observed.Intravitreal injection of 2.5 mg bevacizumab has the same efficacy as 1.25 mg, but may be associated with a higher rate of adverse events.

PURPOSE: To compare the sensation recovery, scar formation, and histopathologic aspects of upper blepharoplasty eyelid incision performed with radiofrequency or scalpel. METHODS: In a prospective, randomized, blind, comparative, interventional study, 46 eyelids from 23 subjects underwent upper blepharoplasty using radiofrequency incision on one side and a scalpel on the other side. Exclusion criteria were diseases resulting in peripheral neuropathy such as diabetes mellitus, previous upper eyelid surgery or trauma, and history of skin disease. Eyelid sensation was measured preoperatively and 1 week, 1 month, and 6 to 7 months after surgery by a masked observer. Eyelid scar was evaluated by 2 masked observers at final follow-up. Histologic examination for zone and depth of tissue damage, hemorrhage, and inflammatory cell reaction was performed in a masked fashion on 16 eyelids. RESULTS: The mean patient age was 52 years (SD, 5.48 years). Mean aesthesiometry reading significantly decreased in both groups at all follow-up visits in comparison with preoperative measurement (p = 0.000). Mean sensation recovery was insignificantly (0.2 < p < 0.6) higher in the radiosurgery group at all follow-up visits. Mean scar score was insignificantly (p = 0.055 for observer 1, and 0.241 for observer 2) less in the radiosurgery group. The scar score was not significantly different between Fitzpatrick skin types 3 and 4, scored by either observer. The zone and depth of tissue damage on histopathologic examination was greater in the radiofrequency group. However, the hemorrhage and infiltration of inflammatory cells were the same. CONCLUSION: There was no significant difference between radiofrequency and scalpel incision in upper blepharoplasty with regard to sensation recovery and scar formation. Histologic zone and depth of tissue damage were greater in the radiofrequency group. ©2008The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc.

Purpose: To report multimodal imaging characteristics of a patient with pattern macular dystrophy with bilateral submacular fluid. Methods: A 47 year-old man was referred with gradual decrease of visual acuity in both eyes. He had history of bilateral injection of intravitreal bevacizumab with the diagnosis of central serous chorioretinopathy without any clinical effect. Funduscopic and optical coherence tomography examinations revealed bilateral subretinal fluid in the macular area. Results: Fundus autofluorescence, fluorescein angiography and indocyanin green angiography revealed characteristics of butterlfly-shaped macular dystrophy with no leakage in the macular area. Electro-oculography was abnormal. Conclusion: Pattern macular dystrophy may be presented with bilateral subretinal fluid in macula.

PURPOSE: To report an unusual case of sympathetic ophthalmia after successful scleral buckling surgery. METHODS: The authors reported the clinical manifestation, ocular and systemic workup, and outcome of a 23-year-old woman who presented with reduced vision 3 weeks after successful scleral buckling surgery. RESULTS: Slit-lamp examination showed a mild anterior chamber and vitreous reaction. Fundus examination showed extensive serous retinal detachment in both eyes. Systemic workup was negative for extraocular disease. The patient was treated with intensive systemic steroid and azathioprine. The inflammation was controlled and serous detachment resolved. CONCLUSION: Sympathetic ophthalmia can occur after successful scleral buckling surgery.

PURPOSE: To describe the association between vitreous traction on the optic disc and nonarteritic anterior ischemic optic neuropathy (NAION). METHODS: Eighty three eyes of 83 patients with NAION were evaluated by optical coherence tomography (OCT) for detecting vitreous adhesion to the optic nerve head with separation from the adjacent retina (partial posterior vitreous detachment). Eyes which were negative for such adhesion underwent ultrasonography to detect complete posterior vitreous detachment (PVD). RESULTS: Fifty male and 33 female subjects with mean age of 51.9±10 years were studied. Partial PVD with optic nerve head adhesion was found in 54 patients (65.1%) using OCT. Ultrasonography detected complete PVD in all other eyes with optically empty spaces on OCT. CONCLUSION: Vitreous traction on the optic nerve head from partial PVD may play a causative role in some cases of NAION. This traction may impair vascular supply and/or axoplasmic flow leading to signs and symptoms of NAION.

Approximately one-third of the contents of a 1-ml, 40-mg ampule of triamcinolone acetonide was accidentally injected into the subretinal space of the left eye of a 30-year-old man with chronic uveitis. The manufacturer provided a list of the contents of the ampule. A large, white subretinal mass was seen in the superotemporal quadrant. In subsequent days, the medication was seen to migrate interiorly. Visual acuity in the left eye was 20/400. Sub retinal hemorrhage and mild atrophy of the retinal pigment epithelium and choroid were observed superotemporally. Visual acuity returned to 20/100 (preinjection level) in 1 week. Four months postinjection, the superotemporal atrophy was more severe; the inferotemporal medication was minimally visible without producing significant chorioretinal atrophy. The visual acuity remained at 20/100 until the patient underwent cataract extraction and intraocular lens implantation; his vision then improved to 20/40. Steroids, when not accompanied by harmful vehicle substances, may be well tolerated by ocular tissues. [Ophthalmic Surg Lasers 1998;29:935-938.]

Purpose: To report ocular perforation that occurred duringretrobulbar injection in 7 highly myopic eyes.Methods: Seven patients with a diagnosis of globe injuryduring retrobulbar injection for ocular anesthesia beforecataract surgery were managed by vitreoretinal surgery. Allinjections were performed by ophthalmologists. The surgeonrecognized the perforation in 4 cases at the time of injection.The preoperative vision was hand motion perception in 4 eyes andlight perception in 3 eyes. All patients underwent vitreoretinalsurgery because of the presence of vitreous hemorrhage and/orretinal detachment diagnosed by funduscopy or ultrasonography. Atthe time of surgery, all eyes had vitreous hemorrhage and 4 eyeshad rhegmatogenous retinal detachment. The number ofvitreoretinal procedures performed was: 1 procedure in 4patients, 2 procedures in 2 patients, and 3 procedures in 1patient. The period of follow-up ranged from 4 months to 4 years,averaging 20 months.Results: At the end of the follow-up period, the retinawas attached in 6 patients. The postoperative vision was 20/400in 3 eyes, finger counting in 3 eyes, and light perception in 1eye.Conclusion: Special care should be taken in retrobulbarinjection of highly myopic globes, which have an increased riskof perforation. The functional outcome of surgical repair ofthese eyes was poor.

Purpose To assess the rate of infectious endophthalmitis in a single clinical center in Iran and to compare the rate of endophthalmitis in patients receiving postinjection antibiotics with those who did not. Methods A retrospective chart review of patients who received intravitreal injections of bevacizumab was undertaken. Cases of clinical diagnoses of endophthalmitis were reviewed. Bevacizumab was obtained at the time of injection from a commercially available vial after aseptic cleansing of the rubber cover. Results Five patients (six eyes) developed clinical endophthalmitis after the intravitreal bevacizumab injection. The risk per injection was 0.10% (6/5,901). One culture-positive case was found overall. Postinjection antibiotic drops were prescribed for 68% of eyes. All endophthalmitis cases were among those who received postoperative antibiotic eye drops. The difference in the rates of endophthalmitis between those receiving postinjection antibiotics and those who did not was not statistically significant (P = 0.18). Conclusion A low risk of endophthalmitis consistent with the range of previous studies was observed notwithstanding the usage of multiple use of a single vial. Postinjection antibiotic drops may not be necessary.

Crohn disease is an inflammatory bowel disease frequently associated with extraintestinal manifestations. Ocular manifestations are uncommon but may cause significant morbidity, including blindness. We report the first case of a 9-year-old boy with biopsy-proven Crohn disease who developed a cilioretinal artery–sparing central retinal artery occlusion. After 2 months of follow-up, the patient developed optic atrophy with no change in visual acuity.

To evaluate outcomes of intravitreal injection of bevacizumab for the treatment of severe retinopathy of prematurity (ROP) associated with vitreous or retinal hemorrhages (VH or RH).This is a prospective interventional case-series. Fourteen eyes of eight premature infants with severe ROP associated with vitreous or retinal hemorrhage were consecutively included. In eight eyes, VH and/or RH precluding complete laser ablation developed at the time of laser treatment. In six eyes, VH developed early after laser ablation. All participants underwent intravitreal injection of 0.625 mg (0.025 ml) bevacizumab immediately after diagnosis of VH or RH. Follow-up examinations were performed at days 1, 3, 7, and 14, and 1, 2 and 3 months after injection. Main outcome measure was the absence of unfavorable structural outcomes.Mean gestational age was 27.6 weeks (range, 26-29 weeks) and mean birth weight was 1047 g (range, 780-1500 g). Mean gestational age at the time of injection was 35.4 weeks (range, 32-38 weeks). In all eyes, plus disease disappeared completely within 2 weeks and VH and/or RH was absorbed at last follow-up. None of the eyes developed unfavorable structural outcomes. No eyes needed additional injection or laser treatment. No major systemic or ocular complications were observed.In this small series of patients, intravitreal injection of bevacizumab was effective for treatment of severe retinopathy of prematurity associated with vitreous or retinal hemorrhage.

Purpose To evaluate the outcomes of transscleral diode laser photocoagulation for treatment of threshold retinopathy of prematurity (ROP). Methods Retrospective interventional case series of infants with ROP treated at our center with transscleral diode laser retinal photocoagulation. All patients were followed for 2 months, and regression of ROP, unfavorable outcomes, and incidence of adverse effects were assessed. Results A total of 103 eyes of 52 infants with ROP at the threshold stage were treated with transscleral diode laser photocoagulation under topical anesthesia, without conjunctival incision. Supplemental transpupillary diode laser photocoagulation was used for posterior zone 2 and zone 1 in 5 eyes. In 99 eyes (96.1%) neovascularization regressed completely; in 96 eyes (93.2%) the outcome was favorable. In the other 3 eyes, macular dragging formed after regression of neovascularization. Four eyes progressed to more advanced stages of ROP. Repeated laser therapy was performed with the same technique in 10 eyes (9.6%). There was no statistically significant association of unfavorable outcomes with age, birth weight, gestational age, clocks of retinal involvement, and rush disease. No adverse effects of diode laser treatment were observed except for mild injection and edema of conjunctiva in all patients, small conjunctival lacerations in 10 eyes, and small self-limited vitreous hemorrhage in 2 eyes. Conclusions Transscleral laser treatment may be technically easier for the treatment of retinal periphery, especially in poorly dilating pupils, and obviates the occasional anterior segment complications of the transpupillary approach. This technique can be performed under topical anesthesia.

Purpose. The aim of this study was to present normative values of exophthalmometry in Iranian children, teenagers, and adults and find the effect of age, gender, height, weight, and laterality (right vs. left eye) on normal values of protrusion. Methods. In a population-based epidemiological study, ocular protrusion values (mm) were measured in 1063 randomly selected (stratified sampling method) normal subjects using the Hertel exophthalmometer. Weight and height were measured in all subjects. Results. There were 462 (43.5%) females and 601 (56.5%) males. The age ranged from 6 to 70 years (mean SD 20.3 10.9). Subjects were divided into three age groups (years); children (range: 6 to 12, mean: 9.2 1.6), teenagers (range: 13 to 19, mean: 15 1.4), and adults (range: 20 to 70, mean: 31 7.9). The mean (SD) absolute ocular protrusion value was 14.2 1.8 in children, 15.2 1.9 for teenagers, and 14.7 2.3 for adults. Right and left eye protrusions were well correlated (r 0.97, p 0.0005 in children and adults and r 0.95, p 0.0005 in teenagers). However, right eye protrusion was significantly more than on the left side (p 0.0005). Although males had more eye protrusion, the gender difference was not significant except for teenagers. Weight and height did not have a significant effect on eye protrusion. No individual had more than 2 mm of asymmetry (relative eye protrusion). Increasing age had a significant effect on the eye protrusion (r 0.32 for children, r 0.13 for teenagers, and r 0.30 for adults; 0.001 p 0.0005). The ocular protrusion was positively correlated with increasing distance between the two lateral orbital rims (base) in all age groups (p 0.0005). Conclusions. Any eye protrusion of more than 17.8 mm for Iranian children, 19 mm for Iranian teenagers, and 19.3 mm for Iranian adults and relative eye protrusion of more than 2 mm warrants further clinical examination. Age and base value had a significant impact on normal eye protrusion values. (Optom Vis Sci 2008;85:1012–1017)

Osteiod osteoma is a small, benign, osteoblastic tumor, which usually affects the long bone of the lower extremities and vertebrae. Herein, we report the first case of endo-orbital osteoid osteoma. A 22-year-old man presented with eyelid edema, proptosis and pain in the left eye 1 year after the beginning of the symptoms. Imaging studies showed a small (15 × 11 mm in size) lesion on the roof of the left orbit with contrast enhancement. The lesion was removed and histopathological section was consistent with osteoid osteoma. Eighteen month after the operation, the patient was free of symptoms.

A randomized, double-blind, placebo-controlled clinical trial was conducted among 44 subjects to assess the efficacy of EMLA cream application without occlusive dressing on pain on needling (PN) and pain on injection (PI) felt during multiple botulinum toxin type A (BTA) injections for correction of hyperkinetic upper facial lines. Mean PN score was less than PI score with high correlation and no significant difference. Although both PN and PI scores (visual analog) were less in the EMLA than placebo group, the difference was only statistically significant for PN score. Time intervals between the cream application and BTA injections beyond 60 minutes did not show lower pain score in either type of the pain.

Aims: To find the cure rate of late (second year of age) and very late (3–5 years of age) initial probing for congenital nasolacrimal duct obstruction (CNLDO) and to identify the factors contributing to the failure rate of the probing in older children. Methods: In a prospective interventional case series study, 169 eyes of 125 consecutive patients (1–5 years old) with CNLDO underwent probing under general anaesthesia. Cure was defined as absence of tearing and discharge in the affected eye. Results: 138 eyes of 101 patients aged 13–60 months (mean 23.4 (SD 10.2)) were included. Of 15 eyes (10.8%) with complex CNLDO, 80% presented after 24 months of age (p

Purpose: To evaluate the spectrum of organisms causing endophthalmitis and their resistance pattern to standard antimicrobial agents. Materials and Methods: Medical records of culture positive eyes treated at Rassoul Akram Hospital for endophthalmitis during the past 5 years were reviewed. Specimens were obtained during pars plana vitrectomy or vitreous tap. Results: Sixty-five isolates including 36 (55.4%) gram-positive organisms, 28 gram-negative organisms (43.1%), and 1 (1.5%) fungus were studied. The most common organism identified was Coagulase-negative staphylococcus in 16 eyes (24.6%). Among the antibiotics available for intravitreal injection, the least antibiotic resistance was for vancomycin in gram-positive organisms and amikacin and ceftazidime in gram-negative isolates. Conclusions: Gram-positive isolates were the most prevalent organisms; however, a high isolation rate for gram-negative organisms was obtained. Considering that no single antibiotic provides coverage for all of the organisms, a combination therapy using vancomycin/amikacin or vancomycin/ceftazidime seems to be useful as the initial empiric treatment of suspected bacterial endophthalmitis.

To evaluate the use of preoperative intravitreal bevacizumab (IVB) injection in patients undergoing pars plana vitrectomy for complications of proliferative diabetic retinopathy (PDR).In this prospective surgeon-masked randomized clinical trial, 40 eyes of 40 diabetic patients who were candidates for vitrectomy were randomly assigned to receive 2.5 mg IVB 3-5 days before operation (injected group) or no injection before operation (noninjected group). A preoperative complexity score (CS) was recorded. Best-corrected visual acuity, number of endodiathermy applications, backflush needle applications, duration of surgery, and postoperative vitreous hemorrhage were recorded.Twenty-two patients with a CS of 6+/-0.95 in the injected group and 18 patients with a CS of 5.7+/-1.1 in the noninjected group (p=0.3) were studied. Postoperative visual acuities were significantly better than preoperative visual acuities. Preoperative and 3-month postoperative visual acuities were the same for both groups; however, in the last follow-up examinations (mean 7+/- 3.6 months) the injected group had better visual acuities than the noninjected group (1.1+/-0.4 and 1.4+/-0.3 logMAR, respectively, p=0.006). Mean surgical time was 62+/-57.3 minutes in the injected group vs 95.5+/-36 minutes in the noninjected group (p=0.03): endodiathermy applications 6.0+/-4.3 vs 11.0+/-5.8 (p=0.004), backflush cannula applications 11.0+/-7.2 vs 18.1+/-7.8 (p=0.004). In non-silicone-filled eyes, no patient in the injected group developed significant postoperative vitreous hemorrhage obscuring the fundus details, while 7 eyes of noninjected eyes had this complication (p=0.01).IVB injection before vitrectomy for PDR facilitates the surgery, and may decrease the rate of postoperative vitreous hemorrhage and improve the visual acuity results of the operation.

Purpose: To report the outcomes of transscleral diode laser photocoagulation for treatment of type 1 prethreshold retinopathy of prematurity (ROP). Methods: In this prospective interventional case series, 139 eyes of 73 infants with type 1 prethreshold ROP underwent transscleral diode laser photocoagulation of the avascular retina under topical anesthesia without making a conjunctival incision. Supplemental transpupillary diode laser photocoagulation was used for zone 1 ROP in one eye. All patients were followed for 6 months. Main outcome measures were regression of ROP, incidence of unfavorable outcomes and adverse effects. Results: At the end of follow-up, neovascularization regressed completely in all eyes and no eye developed an unfavorable outcome. Repeated laser therapy was performed employing the same technique in 3 eyes (2.3%). Ocular adverse effects were minor including mild conjunctival injection and edema in all patients, small conjunctival lacerations in 12 eyes (8.7%), minor self-limited vitreous hemorrhage in 2 eyes (1.4%) and mild self-limited hyphema in one eye (0.7%). Conclusion: Transscleral diode laser photocoagulation is a safe and effective treatment option for type 1 prethreshold ROP. This technique can be performed under topical anesthesia.