Evaluating the Efficacy and Safety of Aflibercept Biosimilar (P041) Compared with Originator Product in Patients with Neovascular Age-Related Macular Degeneration.

OBJECTIVE: To assess the noninferiority of biosimilar aflibercept (P041, CinnaGen) to the originator aflibercept (AFL, Regeneron) in terms of efficacy, safety, and immunogenicity. DESIGN: This was a phase Ш, 52-week, multicenter, randomized, double-masked, and active control trial involving eyes in a 1:1 ratio. SUBJECTS: Patients with active subfoveal choroidal neovascularization secondary to age-related macular degeneration randomized into the 2 groups of P041 and AFL. METHODS: Patients received an injection of aflibercept every 4 weeks for 3 doses, followed by administration every 8 weeks up to week 48. MAIN OUTCOME MEASURES: The primary outcome was the noninferiority analysis of eyes maintaining vision at week 52. Secondary outcomes included the changes in visual acuity and retinal thickness, safety evaluation, and immunogenicity during the study. RESULTS: In total, 168 eyes of 168 patients were included. At week 52, the proportion of patients maintaining vision was 94.44% in the P041 group compared with 94.52% in the AFL group. The 95% confidence interval (CI) for the difference of maintaining vision from baseline did not exceed the predefined noninferiority margin of 10% (difference, -0.0008; 95% CI, -0.074 to 0.074; P = 0.98). Secondary outcomes indicated similar results in both arms (all P > 0.05). Safety measured outcomes and immunogenicity were similar between the 2 study groups. CONCLUSIONS: Biosimilar aflibercept was noninferior to AFL in eyes with neovascular age-related macular degeneration. Other efficacy and safety findings also indicated the similarity of 2 products. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Non-steroidal intravitreal injection for noninfectious uveitic cystoid macular edema: Systematic review and meta-analysis.

PURPOSE: To systematically review the published manuscripts on the non-steroidal intravitreal injection for treatment of noninfectious uveitic cystoid macular edema (CME). METHODS: The PubMed, Scopus, and Web of Science, Science Direct, ProQuest, Cochrane Library, ProQuest, Embase, Clinical Key, and Springer were searched for relevant articles published until May 2022. The random-effects models were used to estimate the mean difference (MD) and 95% confidence interval (CI) for postoperative central macular thickness (CMT) and visual acuity (VA) changes. VA was transformed into the logarithm of the minimum angle of resolution (LogMAR). Meta-regression was conducted for adjusting the effects of potential confounders. RESULTS: A total of 17 relevant studies (258 eyes) were included in this meta-analysis. A significant improvement was observed in CMT in the last follow up (350.89 ± 108.43) compared to the baseline (452.3 ± 112.67) (Log MD = 1.82, 95% CI = 1.62, 2.02; I2 = 57.7%; P = 0.002). Additionally, VA also significantly improved in the last follow up (0.56 ± 0.29) compared to the baseline (0.75 ± 0.3) (Exponential MD = 0.82, 95% CI = 0.69, 0.95; I2 = 0.0%; P = 0.98). The subgroups analyzed included ten studies on anti-vascular endothelial growth factors (VEGF), three studies on infliximab, two studies on methotrexate (MTX), and two studies on diclofenac. All subgroups showed a significant improvement in both CMT and VA at the last follow-up (P < 0.05). CONCLUSION: Non-steroidal intravitreal injection including bevacizumab, ranibizumab, infliximab, MTX and diclofenac appears to be an effective treatment option for noninfectious uveitic CME.

Automatic Choroidal Segmentation in Optical Coherence Tomography Images Based on Curvelet Transform and Graph Theory.

Background: Automatic segmentation of the choroid on optical coherence tomography (OCT) images helps ophthalmologists in diagnosing eye pathologies. Compared to manual segmentations, it is faster and is not affected by human errors. The presence of the large speckle noise in the OCT images limits the automatic segmentation and interpretation of them. To solve this problem, a new curvelet transform-based K-SVD method is proposed in this study. Furthermore, the dataset was manually segmented by a retinal ophthalmologist to draw a comparison with the proposed automatic segmentation technique. Methods: In this study, curvelet transform-based K-SVD dictionary learning and Lucy-Richardson algorithm were used to remove the speckle noise from OCT images. The Outer/Inner Choroidal Boundaries (O/ICB) were determined utilizing graph theory. The area between ICB and outer choroidal boundary was considered as the choroidal region. Results: The proposed method was evaluated on our dataset and the average dice similarity coefficient (DSC) was calculated to be 92.14% ± 3.30% between automatic and manual segmented regions. Moreover, by applying the latest presented open-source algorithm by Mazzaferri et al. on our dataset, the mean DSC was calculated to be 55.75% ± 14.54%. Conclusions: A significant similarity was observed between automatic and manual segmentations. Automatic segmentation of the choroidal layer could be also utilized in large-scale quantitative studies of the choroid.

Diabetic retinopathy and corneal endothelial parameters: an analytical cross-sectional study.

BACKGROUND: To investigate the possible association of different pattern of diabetic retinopathy (DR) on corneal endothelium cells in type 2 diabetes mellitus patients. METHODS: In this descriptive-analytical cross-sectional study, corneal endothelium parameters including endothelial cell density (ECD), average cell size (AVG), coefficient of variation in cell size (CV), and hexagonality (Hex) were evaluated by non-contact specular microscopy. RESULTS: One hundred and thirty-four eyes of 134 diabetic patients including 77 females (57.5%) with a mean age of 61.03 ± 8.08 years were enrolled. The overall corneal parameters in diabetic patients with and without retinopathy were not significantly different (P > 0.05). There is a significant relationship between CV and the duration of the disease with age variable control (B = 0.369, p-value < 0.001). CONCLUSIONS: Corneal endothelial parameters were not associated with DM in patients without and with DR. There is a significant relationship between CV and the duration of the disease with age variable control.

An Update on Choroidal Layer Segmentation Methods in Optical Coherence Tomography Images: a Review.

Choroid is one of the structural layers, playing a significant role in physiology of the eye and lying between the sclera and the retina. The segmentation of this layer could guide ophthalmologists in diagnosing most of the eye pathologies such as choroidal tumors and polypoidal choroidal vasculopathy. High signal-to-noise ratio and high speed imaging in Spectral-Domain Optical Coherence Tomography (SD-OCT) make choroidal imaging feasible. Several variables such as pre-operative axial length (AXL), time of day and age affect thickness of the choroidal vascularization and should be considered for segmentation of this layer. These days most of the eye specialists manually segment the choroidal layer which is time-consuming, tiresome and dependent on human errors. To overcome these difficulties, some studies have introduced different automatic choroidal segmentation methods. In this paper, we have conducted a comprehensive review on existing recently published methods for automatic choroidal segmentation algorithms.

Livelayer: a semi-automatic software program for segmentation of layers and diabetic macular edema in optical coherence tomography images.

Given the capacity of Optical Coherence Tomography (OCT) imaging to display structural changes in a wide variety of eye diseases and neurological disorders, the need for OCT image segmentation and the corresponding data interpretation is latterly felt more than ever before. In this paper, we wish to address this need by designing a semi-automatic software program for applying reliable segmentation of 8 different macular layers as well as outlining retinal pathologies such as diabetic macular edema. The software accommodates a novel graph-based semi-automatic method, called "Livelayer" which is designed for straightforward segmentation of retinal layers and fluids. This method is chiefly based on Dijkstra's Shortest Path First (SPF) algorithm and the Live-wire function together with some preprocessing operations on the to-be-segmented images. The software is indeed suitable for obtaining detailed segmentation of layers, exact localization of clear or unclear fluid objects and the ground truth, demanding far less endeavor in comparison to a common manual segmentation method. It is also valuable as a tool for calculating the irregularity index in deformed OCT images. The amount of time (seconds) that Livelayer required for segmentation of Inner Limiting Membrane, Inner Plexiform Layer-Inner Nuclear Layer, Outer Plexiform Layer-Outer Nuclear Layer was much less than that for the manual segmentation, 5 s for the ILM (minimum) and 15.57 s for the OPL-ONL (maximum). The unsigned errors (pixels) between the semi-automatically labeled and gold standard data was on average 2.7, 1.9, 2.1 for ILM, IPL-INL, OPL-ONL, respectively. The Bland-Altman plots indicated perfect concordance between the Livelayer and the manual algorithm and that they could be used interchangeably. The repeatability error was around one pixel for the OPL-ONL and < 1 for the other two. The unsigned errors between the Livelayer and the manual algorithm was 1.33 for ILM and 1.53 for Nerve Fiber Layer-Ganglion Cell Layer in peripapillary B-Scans. The Dice scores for comparing the two algorithms and for obtaining the repeatability on segmentation of fluid objects were at acceptable levels.

Evaluation of Asymmetry in Right and Left Eyes of Normal Individuals Using Extracted Features from Optical Coherence Tomography and Fundus Images.

BACKGROUND: Asymmetry analysis of retinal layers in right and left eyes can be a valuable tool for early diagnoses of retinal diseases. To determine the limits of the normal interocular asymmetry in retinal layers around macula, thickness measurements are obtained with optical coherence tomography (OCT). METHODS: For this purpose, after segmentation of intraretinal layer in threedimensional OCT data and calculating the midmacular point, the TM of each layer is obtained in 9 sectors in concentric circles around the macula. To compare corresponding sectors in the right and left eyes, the TMs of the left and right images are registered by alignment of retinal raphe (i.e. diskfovea axes). Since the retinal raphe of macular OCTs is not calculable due to limited region size, the TMs are registered by first aligning corresponding retinal raphe of fundus images and then registration of the OCTs to aligned fundus images. To analyze the asymmetry in each retinal layer, the mean and standard deviation of thickness in 9 sectors of 11 layers are calculated in 50 normal individuals. RESULTS: The results demonstrate that some sectors of retinal layers have signifcant asymmetry with P < 0.05 in normal population. In this base, the tolerance limits for normal individuals are calculated. CONCLUSION: This article shows that normal population does not have identical retinal information in both eyes, and without considering this reality, normal asymmetry in information gathered from both eyes might be interpreted as retinal disorders.

Evaluation of optical coherence tomography angiography parameters in patients treated with Hydroxychloroquine.

BACKGROUND: One of the major side effects of Hydroxychloroquine (HCQ) is retinopathy. The aim of this study was to evaluate the Optical coherence tomography angiography (OCTA) parameters in a group of patients who have Hydroxychloroquine-induced retinopathy based on Multifocal electroretinography (mfERG) with a group who do not have retinopathy. METHOD: This is a Cross-Sectional Study. In this study, patients with Rheumatoid arthritis (RA) or Systemic lupus erythematosus (SLE) who had been taking Hydroxychloroquine for at least 7 years were included. MfERG and OCTA imaging were performed for all patients. Patients were divided into Normal mfERG and Abnormal mfERG groups based on mfERG results. OCTA parameters were studied in these two groups. RESULT: Sixty-one patients (61 eyes) were included. Forty-one patients had SLE and 20 patients had RA. Forty patients (66.7%) had Abnormal mfERG. The mean vascular density (VD) in Superficial capillary plexus (SCP) layer was not significantly different between Normal mfERG and Abnormal mfERG groups (P-Value> 0.05). Mean VD in SCP layer was not significantly different between Normal mfERG and Abnormal mfERG groups (P-Value> 0.05). In RA subgroup, mean VD in SCP layer in PeriFovea region in Abnormal mfERG group was significantly lower than normal group (P-Value < 0.05). Mean VD in deep capillary plexus (DCP) layer in Whole Image, Superior Hemi, Inferior Hemi, PeriFovea area in Abnormal mfERG group was significantly lower than normal group (P-Value < 0.05). This discrepancy was also observed in the RA subgroup but not in the SLE subgroup. The mean of none of the parameters of foveal avascular zone (FAZ) (mm2), Flow Area of Outer Retina (mm2) and Flow Area of Choriocapillaris (mm2) were not statistically significant between the groups Abnormal mfERG and Normal mfERG. (p-value> 0.05). CONCLUSION: VD in the DCP layer decreased in abnormal mfERG patients compared to patients with normal mfERG. But it seems that VD in SCP layer, FAZ Area and Flow Area are similar in both groups. OCTA may be used as a non-invasive tool in the diagnosis of early stages of HCQ-induced retinopathy, especially in RA patients, but further studies are needed.

Short-Term Effects of Photodynamic Therapy on Segmentation of Retinal Layers in Central Serous Chorioretinopathy.

BACKGROUND: The present study aims to evaluate the effect of photodynamic therapy (PDT) on the thickness of segmentation layers of the retina in cases with central serous chorioretinopathy (CSCR). MATERIALS AND METHODS: This was a prospective, observational study on cases with CSCR who were candidates for PDT therapy. All patients had undergone at least 1 month of conservative management without satisfactory resolution. PDT was carried out according to the safe half-dose therapy scheme. Spectral-domain optical coherence tomography was employed to evaluate the changes in morphology and segmentation of retinal layers. Patients were followed up for 3 months. RESULTS: Twenty-seven cases (18 males and 9 females) were included. Age of the patients varied from 39 to 59 years (mean: 46.61 ± 12.48 years). Cases were followed for 92.17 ± 3.28 days. Sixteen cases had functional and anatomical improvement by the treatment. Changes in overall retinal (377.39 ± 61.36 to 323.61 ± 71.36; P = 0.004) and all outer retinal segmentation layers including outer plexiform layer (34.93 ± 10.07 to 29.25 ± 6.12; P = 0.008), outer nuclear layer (63.52 ± 30.44 to 46.44 ± 20.62; P = 0.017), and retinal pigment epithelium (40.66 ± 37.73 to 23.78 ± 29.33; P = 0.016) were statistically significant. On the contrary, inner retinal segmentation layers, especially retinal ganglion cell (RGC) layer (38.29 ± 16.63 to 37.26 ± 16.18; P = 0.387), remained statistically unchanged. CONCLUSION: We postulate that PDT alleviates outer retinal edema where fluid accumulation occurs mostly, whereas it does not alter inner retinal and especially RGC layer. These findings may indicate that short-term atrophy of the inner retina did not occur following PDT and may point toward safety of this method for cases with CSCR.

Peripapillary and macular choroidal thickness in both eyes of patients with acute unilateral retrobulbar optic neuritis.

PURPOSE: The purpose of this study was to examine macular and peripapillary choroidal thickness (CT) in patients with acute unilateral retrobulbar optic neuritis. MATERIALS AND METHODS: In this cross-sectional study, 19 patients with acute unilateral retrobulbar optic neuritis were examined. A control group was matched with patients for sex and age. Enhanced depth imaging optical coherence tomography in macula and peripapillary areas in both eyes was performed for evaluation of CT. The CT was measured in subfoveal and other six points of macula and four points of peripapillary areas with a 3.4-mm scan circle centered on the optic nerve head. RESULTS: The mean subfoveal CT was 384.7 ± 101.6 µm, 380.5 ± 109 µm, and 401.2 ± 84.6 µm for affected eye, unaffected fellow eye, and healthy control, respectively. All measurements of macular CT were thinner in the patient group compared with healthy controls. Global peripapillary CT in affected eyes, unaffected fellow eyes, and healthy controls were 202 ± 43.3, 195.1 ± 42.9, and 234 ± 71.2, respectively. The difference between the three groups was statistically significant in the nasal point of peripapillary area (P = 0.023). No correlation was seen between CT and initial visual acuity or duration from symptom onset to medical survey in acute phase of retrobulbar optic neuritis. CONCLUSION: Patients with acute retrobulbar optic neuritis showed no significantly thinner macular and peripapillary CT in both eyes compared with healthy controls.

Forming Optimal Projection Images from Intra-Retinal Layers Using Curvelet-Based Image Fusion Method.

BACKGROUND: Image fusion is the process of combining the information of several input images into one image. Projection images obtained from three-dimensional (3D) optical coherence tomography (OCT) can show inlier retinal pathology and abnormalities that are not visible in conventional fundus images. In recent years, the projection image is often made by an average on all retina that causes to lose many intraretinal details. METHODS: In this study, we focus on the formation of optimum projection images from retinal layers using Curvelet-based image fusion. The latter consists of three main steps. In the earlier studies, macular spectral 3D data using diffusion map-based OCT were segmented into 12 different boundaries identifying 11 retinal layers in three dimensions. In the second step, projection images are attained using conducting some statistical methods on the space between each pair of boundaries. In the next step, retinal layers are merged using Curvelet transform to make the final projection images. RESULTS: These images contain integrated retinal depth information as well as an ideal opportunity to better extract retinal features such as vessels and the macula region. Finally, qualitative and quantitative evaluations show the superiority of this method to the average-based and wavelet-based fusion methods. Overall, our method obtains the best results for image fusion in all terms such as entropy (6.7744) and AG (9.5491). CONCLUSION: Creating an image with more and detailed information made by the Curvelet-based image fusion has significantly higher contrast. There are also many thin veins in Curvelet-based fused image, which are absent in average-based and wavelet-based fused images.

Sensitivity, Specificity, and Accuracy of Color Doppler Ultrasonography for Diagnosis of Retinal Detachment.

PURPOSE: This study evaluated the sensitivity, specificity, and diagnostic accuracy of Color Doppler Ultrasonography (CDUS) in patients with suspected retinal detachment (RD) who underwent surgery. METHODS: In this prospective, observational clinical study, 65 eyes of 65 consecutive patients with suspected RD with opaque media were included. Following a standardized protocol, CDUS of the retina of the affected eye was performed. The sensitivity, specificity, and diagnostic accuracy of CDUS were determined and compared to the findings during surgery. RESULTS: The mean age of patients (18 men and 47 women) was 52.36 years (range: 8-77 years). The sensitivity, specificity, and overall accuracy of ocular CDUS were 91.3%, 88.1%, and 89.2%, respectively. The false-negative rate (negative CDUS images but presence of RD at operation) was 3.1% (2/65) and the false-positive rate (positive CDUS images but absence of RD at operation) was 7.7% (5/65). CONCLUSION: CDUS of the retina could be considered as a promising tool in the diagnosis of RD in patients with opaque media.

Effects of subthreshold diode micropulse laser photocoagulation on treating patients with refractory diabetic macular edema.

PURPOSE: To evaluate the effects of subthreshold diode micropulse laser photocoagulation on treating patients with refractory diabetic macular edema (DME). METHODS: This randomized clinical trial recruited patients with DME in both eyes that were resistant to treatment with intravitreal bevacizumab (IVB). The eyes were randomly divided into two groups who received laser therapy and IVB, or IVB alone. Subthreshold diode micropulse laser photocoagulation and IVB injection were administered in one eye, and an IVB injection was administered in the second eye. IVB injections were repeated in both eyes within one month and two months after the first injection. Best corrected visual acuity (BCVA) logarithm of the minimum angle of resolution (logMAR) and central macular thickness (CMT) were measured before, within a month, and three months after start of intervention. RESULTS: In this study, 42 eyes of 21 patients were evaluated. The mean age of patients was 60.86 ± 8.57 years. Ten patients (47.6%) were male. Within-group analysis showed a significant decreased in BCVA logMAR in the laser + IVB group reflecting improvement in visual acuity (VA) (P < 0.001); it increased in the control group during study reflecting more vision loss (P = 0.01). In the laser + IVB group, a significant decrease in mean ± standard deviation (SD) CMT at 3 months compared to baseline was observed (baseline: 513 ± 126.29 vs. three months: 408.1 ± 95.28; P < 0.001). The mean ± SD CMT was significantly lower in the laser + IVB group of eyes than in the control group three months after intervention (P = 0.02). CONCLUSION: Using subthreshold diode micropulse laser photocoagulation in combination with IVB can significantly reduce CMT and improve BCVA in patients with refractory DME.

Targeted next generation sequencing reveals genetic defects underlying inherited retinal disease in Iranian families.

Purpose: Inherited retinal diseases (IRDs) are clinically and genetically heterogeneous showing progressive retinal cell death which results in vision loss. IRDs include a wide spectrum of disorders, such as retinitis pigmentosa (RP), Leber congenital amaurosis (LCA), cone-rod dystrophy (CRD), and Stargardt disease (STGD1). Methods: In this study, we performed targeted next-generation sequencing based on molecular inversion probes (MIPs) that allowed the sequence analysis of 108 IRD-associated genes in 50 Iranian IRD probands. Results: The sequencing and variant filtering led to the identification of putative pathogenic variants in 36 out of 50 (72%) probands. Among 36 unique variants, we identified 20 novel variants in 15 genes. Four out of 36 probands carry compound heterozygous variants, and 32 probands carry homozygous variants. Conclusions: Employing a cost-effective targeted next-generation sequencing procedure, we identified the genetic causes of different retinal disorders in the majority of Iranian families in this study.

The comparison of retinal blood flow after scleral buckling surgery with or without encircling procedure.

AIM: We aimed to compare peak systolic velocity of central retinal artery (PSV.CRA) and peak systolic velocity of ophthalmic artery (PSV.OA) between patients with retinal detachment who were treated with segmental scleral bucking and scleral buckling with encircling procedure. MATERIALS AND METHODS: This study was a descriptive-analytic cross sectional study that was performed in Isfahan university referral centers since April 2010 to April 2011. Of the patients who have undergone scleral buckling surgery, 20 patients belonging to two groups were randomly selected to enroll in the study. Study groups were, patients who have undergone segmental scleral buckling and the other group were patients who have undergone scleral buckling with encircling procedure. Patients were invited to perform color Doppler imaging. PSV-RA and PSV-OA were measured and documented in both operated and unoperated eyes. All of the Doppler's performed at least three months after ophthalmic surgery. RESULTS: We found significant decrease in PSV.CRA among patients in both groups. In patients who had undergone scleral buckling with encircling procedure PSV.CRA was 11.03 ± 3.04 (cm/sec) and 14.83 ± 4.80 in operated and unoperated eye respectively (P = 0.03). In other hand, who treated with segmental scleral buckling these parameters were 11.02 ± 2.48 and 14.45 ± 4.69 (P = 0.03). PSV.OA did not change significantly in each method. The difference between mean PSV.CRA and PSV.OA in operated eye between two study groups was not significant. CONCLUSION: PSV.CRA reduced significantly in both surgery methods and PSV.OA changes was not significant. However, the mean PSV.CRA and PSV.OA changes did not show statistically significant difference between surgery methods.

Analysis of foveal avascular zone for grading of diabetic retinopathy severity based on curvelet transform.

INTRODUCTION: Diabetes disturbs many parts of the body. One of the most common and serious complications of this disease is Diabetic Retinopathy (DR). In this process, blood vessels of the retina are damaged and leak into the retina. In later stages, DR affects the fovea. In these cases, the shape and size of the Foveal Avascular Zone (FAZ), which is responsible for central vision, can become abnormal and contribute to loss of vision. METHODS: In this paper, appropriate features are extracted from the FAZ by means of Digital Curvelet Transform (DCUT) and used to grade of retina images into normal and abnormal classes. For this reason, DCUT is applied on enhanced color fundus images and its coefficients are modified to highlight vessels and the optic disc (OD). Through the use of this information about the anatomical location of the FAZ related to the OD and detected end points of segmented vessels, the FAZ is extracted. Then, the area and regularity of the extracted FAZ is determined and used for DR grading. RESULTS: Our method was tested on a database including 45 normal and 30 abnormal color fundus images, and showed sensitivity of 93 % for DR grading and specificity of 86 % for distinguishing between normal and abnormal cases. CONCLUSIONS: This technique showed high reproducibility in characterizing the size and contour of the FAZ in diabetic maculopathy, thus it has the potential to serve as a powerful tool in the automated assessment and grading of images in a routine clinical setting.

A comparative study of complications of cataract surgery with phacoemulsification in eyes with high and normal axial length.

BACKGROUND: This study performed to assess the safety of cataract extraction with phacoemulsification and intraocular lens (IOL) implantation in patients with high axial length compared with patients with normal axial length. MATERIALS AND METHODS: A total of 866 eyes were enrolled in this study; all subjects underwent phacoemulsification and IOL implantation for treatment of cataract. Seven hundred and nine eyes fell in the normal group with axial lengths ranging between 21 and 24.5 mm, and 157 eyes were considered myopic with axial length equal or greater than 26 mm. The two groups were compared regarding intraoperative surgical complications, such as vitreous loss, posterior capsular rupture, nucleolus drop, and undesirable implantation of IOL in the anterior chamber. RESULTS: Age was a risk factor in both groups, with each year increase of age, the chance of incidence of intraoperative complications increased 1.04-folds (P = 0.03). And with 1 mm increase in axial length, the incidence of complications raised 1.22-folds (P = 0.007). There was no significant correlation between axial length and incidence of vitreous loss, although the incidence of posterior capsular rupture and nucleus fragment drops increased with increment in the axial length. Sex of the patients and side of the left or right eye were not found to be significant risk factors. CONCLUSIONS: As the results illustrate, in this survey, age and high axial length were statistically significant risk factors for incidence of intraoperative complications of cataract surgery with phacoemulsification technique. Anticipation of these complications and also preparation and prophylactic measures may decrease incidence of these complications.

Bilateral angle-closure glaucoma in a young female receiving cabergoline: a case report.

PURPOSE: To report a case of bilateral acute angle-closure glaucoma after oral administration of cabergoline for the treatment of galactorrhea. METHODS: A diagnosis of secondary drug-induced angle-closure glaucoma was made in a patient with elevated intraocular pressure (IOP) and myopic refractive shift, which was confirmed by ultrasound biomicroscopy (UBM) of the ciliary body and anterior segment, sonography, and optical coherence tomography. The treatment included the discontinuation of the culprit drug and the administration of topical anti-glaucoma drops. The treatment course was followed with serial measurements of the IOP and refraction, and with performing UBM. RESULTS: Five hours after he received a single 0.5-mg oral cabergoline tablet, the patient suffered from acute secondary angle-closure glaucoma and myopic refractive error. UBM demonstrated both effusion of the ciliary body and an anterior rotation of the iris-ciliary body. IOP was reduced 8 h after cessation of the causative agent and administration of anti-glaucoma drops. Refractive errors returned to normal levels after 8 days. CONCLUSION: Secondary acute angle-closure glaucoma has been reported to occur after the administration of some drugs. In this report, an attempt has been made to describe this adverse reaction after oral cabergoline intake.

Cefazolin-Gentamicin versus Vancomycin-Ceftazidime Eye Drops for Bacterial Corneal Ulcers;a Randomized Clinical Trial.

PURPOSE: To compare the efficacy of topical cefazolin-gentamicin versus vancomycinceftazidime for treatment of bacterial corneal ulcers. METHODS: This randomized double-masked clinical trial was performed on consecutive patients with bacterial corneal ulcers referred to Feiz Hospital, Isfahan, Iran from 2004 to 2005. Patients were randomly assigned to cefazolin-gentamicin or vancomycin-ceftazidime eye drops in a masked fashion. Outcome measures included time for resolution of stromal infiltration, re-epithelization of the epithelial defect, and clearance of anterior chamber inflammation as well as culture results and complications. RESULTS: The study included 89 eyes of 89 patients with bacterial corneal ulcers consisting of 57 (64%) male and 32 (36%) female subjects. Specimens were culturenegative in 46% of cases. Forty-one eyes received cefazolin-gentamicin and 48 eyes were treated with vancomycin-ceftazidime. Time for resolution of stromal infiltration was 17.7± 4.3 days versus 13.8± 3.6 days (P=0.04), time to complete re-epithelization was 13.2± 3.1 days versus 9.6± 2.7 days (P=0.01) and time for clearing of the anterior chamber was 11.6± 2.9 days versus 8.1± 2.3 days (P=0.04) in the cefazolin-gentamicin and vancomycin-ceftazidime groups, respectively. The most common complaint related to the medications was ocular burning in 73.1% of patients treated with cefazolingentamicin and 62.9% of cases receiving vancomycin-ceftazidime (P=0.007). CONCLUSION: Vancomycin-ceftazidime eye drops seem to be more effective than cefazolin-gentamicin eye drops for the treatment of bacterial corneal ulcers and are probably better tolerated locally.