Short-Term Effects of Adding Topical Ketorolac to Intravitreal Bevacizumab in Diabetic Macular Edema: A Crossover Randomized Clinical Trial.

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

Impact of coronary artery bypass grafting surgery on the chorioretinal biomicroscopic characteristics.

BACKGROUND: Most patients with cardiovascular disorders suffer from coronary artery diseases, which can be treated successfully using coronary artery bypass grafting (CABG). One of the unpleasant events following CABG is postoperative vision loss (POVL). Vulnerability of retinal vessels to hemodynamic changes, an expectable event following CABG, may contribute to the development of POVL, which might be associated with the changes in the choroidal and retinal structures. AIM: To investigate postoperative changes in chorioretinal and peripapillary nerve fiber layer (NFL) thickness, and progression of diabetic and hypertensive retinopathy after CABG. METHODS: In this prospective, cross-sectional study, 49 eyes in 25 candidates for CABG underwent both ophthalmic and cardiovascular examinations within 6 mo prior to and 9 mo after surgery. RESULTS: Among the study participants, 56% were male with a mean age of 62.84 years ± 10.49 years (range 33-80 years). Diabetes mellitus was observed in eight participants (32%). None of the patients suffered from postoperative anterior or posterior ischemic optic neuropathy, central retinal artery occlusion, and cortical blindness. The mean value of the preoperative best corrected visual acuity was 0.11 ± 0.10 logMAR (range, 0-0.4), which worsened to 0.15 ± 0.08 logMAR (range, 0-0.4) after CABG (P = 0.031). No significant difference was observed between the pre- and postsurgical choroidal (P = 0.853) and macular (P = 0.507) thickness, NFL thickness in the subfoveal (P > 0.999) and peripapillary areas (P = 0.659), as well as the severity of diabetic and hypertensive retinopathy. CONCLUSION: CABG may reduce visual acuity without affecting ocular structures. Postoperative vision reduction might be attributable to molecular or cellular variations, changes in visual pathway function, or central nervous system.

Berlin's Edema with Atypical Optical Coherence Tomography Findings: A Case Report.

Berlin's edema is an acute traumatic maculopathy following ocular blunt trauma, with the major site of injury is photoreceptor outer segments and retinal pigment epithelium (RPE). Optical coherence tomography (OCT) is a useful tool to diagnose and follow microstructural changes in Berlin's edema. In this report, we present an atypical case of Berlin's edema that resembled Vogt-Koyanagi-Harada disease. OCT demonstrated multiple neurosensory detachments and giant cystic changes of the outer retina. Fluorescein angiography showed no dye leakage or vascular alterations. The patient was treated with a short period of topical and systemic corticosteroids, and she improved significantly within a few weeks.

Intravitreal Injections and Face Masks: Endophthalmitis Risk Before and During the COVID-19 Pandemic.

Purpose: To assess the added risk of acute endophthalmitis after intravitreal injections associated with the widespread use of face masks during the COVID-19 pandemic. Methods: In this retrospective, single-center study, records of patients with acute endophthalmitis following intravitreal bevacizumab (IVB) injections during the pre-COVID era-that is, March 1st, 2013 to October 31st, 2019 -and the COVID-19 era-that is, March 1st, 2020 to April 1st, 2021 -were reviewed and compared. Results: A total of 28,085 IVB injections were performed during the pre-COVID era; nine eyes of nine patients developed acute post-IVB endophthalmitis in this era, giving an overall incidence of 0.032% (3.2 in 10,000 injections). In the COVID era, 10,717 IVB injections were performed; four eyes of four patients developed acute post-IVB endophthalmitis in this era, giving an overall incidence of 0.037% (3.7 in 10,000 injections). The incidences of post-IVB endophthalmitis during these two eras were not statistically significantly different (P = 0.779). Conclusion: Face masking protocols seem unlikely to impose any additional risk of post-IVB endophthalmitis.

The effect of topical ketorolac tromethamine on macular thickening after phacoemulsification in diabetic patients.

BACKGROUND: To determine the effect of ketorolac tromethamine 0.5% in preventing post-phacoemulsification macular thickening. This randomized clinical trial. patients randomized 1:1 to receive either topical ketorolac three times a day or a placebo. METHODS: A total of 101 eyes of 101 diabetic patients who were scheduled for phacoemulsification and had normal macular contour and thickness enrolled consecutively. The topical ketorolac and placebo were prescribed on the day before surgery and continued up to 4 weeks after surgery. Patients with proliferative diabetic retinopathy, a history of intravitreal injection in less than three months, a history of macular photocoagulation in less than 6 months, and any other concomitant ocular pathologies were excluded. Central macular thickness (CMT) and best corrected visual acuity (BCVA) was recorded in the follow-ups of 6, 12, and 24 weeks after the surgery and compared with the controls. RESULTS: 49 eyes in the case group and 52 eyes in the control group were analyzed. Mean BCVA was significantly improved in both groups at all follow-ups (P < 0.001 for all). There was no statistically significant difference regarding the BCVA in different time points except week 12 (P = 0.028) among the study group. In the case and control groups, CMT was increased at all follow-ups (P < 0.05). There was no statistically significant difference when comparing the two groups regarding the mean of CMT at any time point postoperatively (P > 0.05 for all). CONCLUSION: Based on our findings, topical ketorolac tromethamine 0.5% is not effective in the prevention of post-phacoemulsification macular thickening in diabetic patients. TRAIL REGISTRATION: The study protocol was registered into www. CLINICALTRIAL: gov with the RCT registration number NCT03551808. (2018/06/11 ) CLINICAL TRIAL REGISTRATION NUMBER: NCT03551808.

Pars plana lensectomy and iris-claw Artisan intraocular lens implantation in patients with Marfan syndrome.

RATIONAL: The rationale of this study was to evaluate the visual and anatomical outcomes of pars plana lensectomy and iris-claw Artisan intraocular lens (IOL) implantation in patients with subluxated crystalline lenses secondary to Marfan syndrome. MATERIALS AND METHODS: In this retrospective case series, we evaluate the records of 21 eyes of 15 patients with Marfan syndrome and moderate-to-severe crystalline lens subluxation who underwent pars plana lensectomy/anterior vitrectomy and implantation of iris-claw Artisan IOL at referral hospital from September 2015 to October 2019. RESULTS: Twenty-one eyes of 15 patients (10 males and five females) with a mean age of 24.47 ± 19.14 years were included. Mean best-corrected visual acuity was improved from 1.17 ± 0.55 logMAR to 0.64 ± 0.71 logMAR at the final follow-up visit (P < 0.001). The mean intraocular pressure did not change significantly (P = 0.971). The final refraction showed a mean sphere of 0.54 ± 2.46 D and a mean cylinder of 0.81 ± 1.03 at the mean axis of 57.92 ± 58.33 degrees. One eye developed rhegmatogenous retinal detachment 2 months after surgery. CONCLUSIONS: Pars plana lensectomy and iris-claw Artisan IOL implantation seem to be a useful, impressive, and safe procedure with a low rate of complications in Marfan patients with moderate-to-severe crystalline lens subluxation. Visual acuity was significantly improved with acceptable anatomical and refractive outcomes.

Optical coherence tomography angiography parameters after cataract surgery.

PURPOSE: To evaluate the changes in macular blood flow after cataract surgery through optical coherence tomography angiography (OCT-A). METHODS: In this prospective case series, 50 patients who underwent uncomplicated cataract surgery by the resident were included. OCT-A images and complete ocular examinations were performed at baseline, 1 and 3 months postoperatively. The changes in OCT-A parameters including foveal avascular zone (FAZ) area, vessel density (VD) of superficial and deep plexus, and central macular thickness were assessed before and after surgery. Cataract grading, intraocular inflammation, and duration of surgery were analyzed. RESULTS: FAZ was significantly reduced from 0.36 ± 0.13 mm2 at baseline to 0.32 ± 0.12 mm2 at month 1 (P < 0.001) and this reduction continued until month 3. In the superficial layer, vessel density of the fovea, parafovea, and whole image significantly increased from 13.9 ± 6.8, 43.7 ± 4.7, and 43.2 ± 4.4 at baseline to 18.4 ± 7.9, 45.7 ± 4.9, and 44.9 ± 4.5 at month 1. The increase in the vessel density of the deep layer was similar to the superficial layer. Accordingly, CMT at the fovea was significantly increased from 240.5 ± 21.99 µm at baseline to 253.1 ± 23.2 microns at month 1 (P < 0.001) and the increase significantly continued and reached 259.5 ± 22.6 µm at month 3 (P < 0.001). Accordingly, the FAZ area significantly reduced one month postoperatively. In regression analysis, CMT changes positively correlated with cataract grading. FAZ area negatively correlated with intraocular inflammation on the first postoperative day. CONCLUSION: The present study shows that CMT and vessel density of the macula significantly increase after uncomplicated cataract surgery, while the FAZ area reduces. Postoperative inflammation could be the possible explanation for the findings of this study.

Outcomes of combined phacoemulsification/intraocular lens implantation and silicon oil removal.

PURPOSE: To evaluate the outcomes and complications of simultaneous silicon oil removal (SOR) and phacoemulsification and intra ocular lens implantation. METHODS: In this retrospective non-comparative case series, the visual, refractive and anatomical outcomes of patients who underwent combined phacoemulsification/silicone oil removal (5700 centistokes) surgery between 2017 and 2019 in a single center were evaluated. RESULTS: Forty-four eyes of 44 patients (eighteen males) were included. The mean age of the patients was 51.45 ± 11.59 years. The primary pathology was tractional retinal detachment (TRD) secondary to diabetic retinopathy in 36 eyes and rhegmatogenous retinal detachment (RRD) in 8 eyes. The median time period between silicone oil tamponade and removal was 9 months. There was no statistically significant difference between best corrected visual acuity (-0.14 ± 0.69 LogMAR, p= 0.19) and intraocular pressure (p= 0.26) before and after the surgery. Mean post-operative spherical equivalent (SE) at last visit was 0.36 ± 1.64 which was different from the target refraction (- 0.5D). After cataract/SOR surgery, one eye (2.3%) developed retinal re-detachment in RRD patient. Vitreous hemorrhage occurred in nine eyes (20.5%) which all had TRD as the primary pathology. CONCLUSION: Combined phacoemulsification, silicone oil and IOL implantation removal surgery seems to be a safe and useful procedure with high success rate and acceptable visual, refractive and anatomical outcomes.

PANRETINAL PHOTOCOAGULATION VERSUS INTRAVITREAL BEVACIZUMAB VERSUS A PROPOSED MODIFIED COMBINATION THERAPY FOR TREATMENT OF PROLIFERATIVE DIABETIC RETINOPATHY: A Randomized Three-Arm Clinical Trial (CTPDR Study).

PURPOSE: To compare safety and therapeutic effect of three treatment protocols on patients with naive proliferative diabetic retinopathy. METHODS: A total of 207 eyes with proliferative diabetic retinopathy were randomly divided into three groups: full panretinal photocoagulation group; intravitreal bevacizumab (IVB) group with four monthly IVB injections; and modified combination group with two bimonthly IVB injections and a modified laser therapy. The best-corrected visual acuity and area of neovascularization leakage were compared at 1-year follow-up. RESULTS: The difference in final best-corrected visual acuity was not significant between the groups (P = 0.77). The modified combination group had the lowest final leakage area (P = 0.006). The difference in final mean deviation of visual field was not significant between IVB and modified combination groups (mean difference = 0.25, P = 0.23, 95% confidence interval, 0.12-1.38). There was no difference in rate of new-onset diabetic macular edema between IVB and modified combination groups (mean difference = 1.5%, P = 0.31, 95% confidence interval, 1.1-1.88). Mean of total IVB injections were 3.5, 7.4, and 6.2 for panretinal photocoagulation, IVB, and modified combination groups, respectively (P = 0.002). Patients in the IVB group underwent more visits (P = 0.001). In subgroup analysis, the difference in the final leakage area was significant for the eyes with diabetic macular edema (P = 0.005). CONCLUSION: A combination protocol of photocoagulation and IVB can be recommended for proliferative diabetic retinopathy, especially with baseline diabetic macular edema.

Electrodiagnostic signs of carpal tunnel syndrome in ocular pseudoexfoliation syndrome.

PURPOSE: To assess the occurrence and severity of electrodiagnostic signs of carpal tunnel syndrome (ED-CTS) in patients with ocular pseudoexfoliation (PEX) and compare them with normal subjects. METHOD: A cross-sectional study with comparison group was designed and 60 patients with PEX were recruited from May 2019 to February 2021, and the findings were compared with 59 healthy subjects. All patients underwent complete ophthalmologic examination and nerve conduction velocity test at the median nerve was used to assess the occurrence and severity of ED-CTS in both hands. RESULTS: The mean age of participants was 59.8 ± 4.5 years. Occurrence of ED-CTS was 38.3% in PEX patients and 20.3% in control subjects (P = 0.025). There was also a significant difference in the severityand presence of asymptomatic CTS (P < 0.05). Adjusting other variables, including; age and sex, having severe ED-CTS showed a 3.07fold higher chance in the PEX group (P = 0.005). CONCLUSION: According to our finding, it seems there is a direct association between PEX and the occurrence, as well as severity of ED-CTS.

SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY BIOMARKERS OF RETINAL HYPERPERMEABILITY AND CHOROIDAL INFLAMMATION AS PREDICTORS OF SHORT-TERM FUNCTIONAL AND ANATOMICAL OUTCOMES IN EYES WITH DIABETIC MACULAR EDEMA TREATED WITH INTRAVITREAL BEVACIZUMAB.

PURPOSE: To assess spectral domain optical coherence tomography biomarkers of short-term outcomes in eyes with diabetic macular edema treated with intravitreal bevacizumab. METHODS: In a prospective interventional case series, 66 eyes with diabetic macular edema underwent 3 monthly intravitreal bevacizumab injections. Best-corrected visual acuity measurement and spectral domain optical coherence tomography were performed at baseline and at 3 months. Multivariate regression analysis was performed to investigate the baseline spectral domain optical coherence tomography parameters as predictors of functional and anatomical outcomes. RESULTS: Patients with diabetic nephropathy had greater subfoveal choroidal thickness (300.8 ± 35.54 vs. 253.0 ± 50.07 µm, P < 0.01) and were more likely to have subretinal fluid (r = 0.26, P = 0.03) at baseline. Multivariate analysis showed that the extent of external limiting membrane disruption (P = 0.03) and the extent of disorganization of retinal inner layers (P = 0.03) at baseline were predictors of best-corrected visual acuity at 3 months, whereas the extent of disorganization of retinal inner layers (P = 0.04) and duration of diabetes mellitus (P = 0.03) were predictors of central subfield thickness at 3 months. CONCLUSION: External limiting membrane disruption and disorganization of retinal inner layers, as the spectral domain optical coherence tomography biomarkers of retinal hyperpermeability, can predict short-term outcomes in diabetic macular edema eyes treated with intravitreal bevacizumab.

Update on Management of Non-proliferative Diabetic Retinopathy without Diabetic Macular Edema; Is There a Paradigm Shift?

Diabetic retinopathy (DR) is the major cause of visual impairment and blindness in the working-age population. Conventional management for nonproliferative diabetic retinopathy (NPDR) without diabetic macular edema (DME) is derived from the findings of the Early Treatment Diabetic Retinopathy Study (ETDRS). Although the ETDRS protocol basically includes observation, selected cases of severe NPDR may undergo scatter laser photocoagulation. Post-hoc analysis of recent trials has shown that patients with NPDR receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) for DME would experience improvement in the DR severity scale (DRSS). In addition, recent randomized trials (PANORAMA and Protocol W) have revealed that early intervention with intravitreal aflibercept in eyes with moderately severe to severe NPDR is associated with significant improvement in DRSS and reduced vision-threatening complications of DR. Based on recent studies, it seems that the therapeutic approach to NPDR may undergo a substantial change and a paradigm shift toward considering early intervention with the administration of intravitreal anti-VEGF injections. However, the long-term results and the duration of adherence to anti-VEGF therapy for eyes with NPDR are not yet defined. It is also not apparent whether improvement in DRSS is a true disease modification. Studies showed that DRSS improvement is not associated with retinal reperfusion. In addition, DRCR.net Protocol W showed no visual acuity benefit with the early intravitreal aflibercept injection in moderate to severe NPDR as compared with performing observation plus intravitreal aflibercept applied only after progression to proliferative DR or vision-impairing DME. The cost-benefit ratio is also a challenge. Herein, we look at different aspects of early anti-VEGF application and discuss its pros and cons in the process of treating NPDR.

Axial or coronal CT scan; which is more accurate in detection of open globe injury?

PURPOSE: To evaluate and compare the accuracy of axial versus coronal computerized tomography (CT) scan in detection of open globe injury. METHOD: In this retrospective study, records of 61 patients with open and 72 patients with closed globe injury were reviewed. One experienced ophthalmologist and one neuroradiologist read the orbital CT scans and accuracy of the axial and coronal planes in detecting open globe injuries were compared. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated and compared for axial and coronal planes. RESULT: The most common CT finding reported by the readers through the interpretation chart was scleral irregularity (70%), followed by dislocation of the crystalline lens (54%) and vitreous hemorrhage (51%). The sensitivity of axial, coronal and combined CT planes were 74%, 65%, and 79%, respectively. There was no significant difference between axial and coronal CT scans for detecting open globe injuries (P value=0.075), independent of the type and the location of the globe injury. For posterior injuries and sharp trauma, the sensitivity of coronal plane in detecting open globe injury was significantly lower, compared to axial and combined readings (P value=0.012 and 0.015, respectively). There was a near perfect agreement between readers for all CT scan readings with a Kappa value of 0.9. CONCLUSION: Axial CT reading may be as adequate as a multiplanar reading in detection of open globe injury in emergency setting, where timely diagnosis matters. Without clinical and surgical findings, CT cannot provide adequate accuracy for detecting open globe injuries.

Topical ketorolac as an adjunctive treatment with intravitreal bevacizumab in the management of diabetic macular edema: A double-masked placebo-controlled randomized clinical trial.

PURPOSE: To evaluate the additional effect of ketorolac eye drops on therapeutic effects of intravitreal Bevacizumab in patients with diabetic macular edema (DME) METHODS: In a randomized clinical trial, 50 patients with center involved DME (macular thickness ≥ 300 microns accompanied by decreased VA (24 < BCVA ≤ 70 ETDRS letters) were enrolled consecutively and randomized 1:1 to receive either bevacizumab plus topical ketorolac (25 patients) or bevacizumab plus artificial tears (25 patients). Patients with proliferative diabetic retinopathy, history of intraocular surgery, intravitreal injection in less than three months, macular photocoagulation less than 6 months and any other concomitant ocular pathologies were excluded from the study. All the patients received three consecutive monthly injections of intravitreal bevacizumab (IVB). After that, patients were examined every 6 weeks and reinjection was administered based on the "as needed" protocol if macular thickness was 300 microns or more and VA was 70 ETDRS letters or less.. Patients also received either topical ketorolac or artificial tears three times a day over the study period (6 months). Changes in central subfield thickness (CST), best-corrected visual acuity (BCVA, ETDRS letters), and number of IVB injections were compared between the study groups. RESULTS: Fifty eyes of 50 patients were included (25 eyes in each group). Mean CST was significantly decreased in both study groups at 14th week (-87 ± 98 µm, P = 0.012 and -100 ± 147 µm, P = 0.006 in bevacizumab plus ketorolac and bevacizumab plus artificial tears groups, respectively). Nevertheless, the changes of mean CST remained significant only in bevacizumab plus ketorolac group up to 26th week (-147 ± 124 µm, P < 0.001 and -51 ± 145 µm, P = 0.245, respectively). Comparing two groups, reduction of mean CST from baseline was significantly greater in bevacizumab plus ketorolac group compared with the control group at 26th week. (difference = -97 µm, 95%CI = -182 to -11, P = 0.017). In the study group, mean BCVA significantly increased at both 20th week (6.2 ± 10.1, P = 0.04) and 26th week (8.2 ± 10.9, P = 0.03). In contrast, visual acuity did not significantly improve at any time points in bevacizumab plus artificial tears group, While insignificant, the 26-week mean change of visual acuity from baseline was greater in bevacizumab plus ketorolac group (difference = 6.5 ETDRS letter; 95%CI = -14.4 to 1.4) Two groups were comparable regarding number of IVB injections (P = 0.99). CONCLUSION: Topical ketorolac 0.5% three times a day could enhance and sustain the efficacy of intravitreal bevacizumab in the treatment of DME.

The effect of systemic erythropoietin and oral prednisolone on recent-onset non-arteritic anterior ischemic optic neuropathy: a randomized clinical trial.

BACKGROUND: To evaluate the effect of systemic erythropoietin, as well as oral steroids, in the management of recent-onset non-arteritic anterior ischemic optic neuropathy (NAION). METHOD: Patients diagnosed with NAION within 5 days were randomized into group A (systemic erythropoietin), group B (oral steroids), and group C (control). Group A received 10,000 units of erythropoietin twice a day for 3 days. Group B received oral prednisone 75 mg daily tapered off in 6 weeks. RESULTS: The mean best-corrected visual acuity (± SD) at the time of presentation was 1 ± 0.56, 1.01 ± 0.6, and 0.94 ± 0.47 logMAR in groups A, B, and C, respectively (P = 0.140); corresponding values at 6-month follow-up were 0.70 ± 0.44, 0.73 ± 0.35, and 0.75 ± 0.39 logMAR, respectively (P = 0.597). Fifty-five percent of patients in group A versus 34.3% in group B and 31.2% in group C had an improvement of at least 3 lines in the best-corrected visual acuity values at the 6th month of follow-up visit (P = 0.04). Peripapillary retinal nerve fiber layers at presentation were 189 ± 58, 193 ± 64, and 199 ± 62 micrometers, respectively (P = 0.779), which decreased to 88 ± 12, 74 ± 25, and 71 ± 18, respectively at 6-month follow-up (P = 0.041). CONCLUSION: The findings of our study indicate the beneficial effects of systemic erythropoietin in preserving the function and structure of the optic nerve in recent-onset NAION. TRIAL REGISTRATION: Clinical registration number: IR.SBMU.ORC.REC.1397.18.

Eye Care Utilization in A Community-oriented Mobile Screening Programme for Improving Eye Health in Iran: A Cluster Randomized Trial.

PURPOSE: To evaluate the effect of a mobile-based screening programme on eye care utilization in Iran. METHOD: In this cluster randomized community trial, a representative sample of residents aged≥50 years from urban and rural areas in four districts in Tehran province were enrolled. The clusters were randomly assigned to one of the three parallel arms; the mHealth arm with digital data collection, vision screening test and retina evaluation using an integrated mobile application, the conventional arm with manual data collection and screening tests using Snellen chart and Fundus photography at the local primary healthcare facility, and the control arm with manual data collection without screening tests. The main outcome measure was eye care utilization which was defined as at least one visit to an optometrist or ophthalmologist. RESULTS: Of 3312 eligible individuals, 2520 (76.1%) participated. In the first 3 months after the screening programme, eye care utilization was higher among those who were referred by the mHealth method (35.6% 95%CI: 31.1-40.4%) compared to those referred by the conventional method (32.7%, 95%CI: 27.5-38.2%) and to those observed in the control arm (4.5%, 95%CI: 3.2-6.0). Eye care utilization improved (OR = 1.5, 95%CI: 1.2-1.9) among the referred people after the screening programme compared to the utilization before this programme; however, this improvement was significantly higher in the mHealth method (OR: 1.7, 95%CI: 1.2-2.4) compared to the conventional method (OR: 1.2, 95%CI: 0.8-1.8). CONCLUSION AND RELEVANCE: The mobile-based screening programme can significantly improve eye care utilization at the community level.

Choroidal Thickness in Acute Non-arteritic Anterior Ischemic Optic Neuropathy.

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

A Population-based Study on the Prevalence and Associated Factors of Age-related Macular Degeneration in Northern Iran the Gilan Eye Study.

Purpose: To estimate the prevalence and associated factors of AMD in an Iranian population in 2014.Methods: In this population-based cross-sectional study, a total of 2975 Iranian residents (age: ≥50 years) from the urban and rural areas of Gilan province were included. The prevalence of different grades of AMD was determined using the International Age-Related Maculopathy Epidemiological Study Group grading system.Results: Of 2975 eligible individuals, 2587 (87.0%) subjects participated and 2275 (76.5%) subjects (62.6 ± 8.8 years old) had gradable fundus photographs. Age- and sex-standardized prevalence of early and late AMD based on the 2016 Iran census were 13.2% (95% confidence interval [CI], 10.6-16.2) and 0.7% (95% CI, 0.4-1.3), respectively. In multivariate analysis, each decade increase in age was associated with the adjusted odds of any (adjusted odds ratio [AOR] = 1.31, 95% CI, 1.09-1.56; P = .0031), early (AOR = 1.27, 95% CI, 1.06-1.53; P = .012) and late AMD (AOR = 2.39, 95% CI, 1.08-5.28; P = .031). Hyperopia was identified to be less frequent in late AMD (AOR = 0.20, 95% CI, 0.04-0.80; P = .024). No significant association was found between AMD and sex, smoking, outdoor working, diabetes, hypertension, pseudophakia, hyperlipidemia and myopia.Conclusion: Gilan Eye Study demonstrated the first estimate of age-specific AMD prevalence in Iran being compatible with other WHO regions. With the expected increase in the life expectancy and aging of Iranians, the number of people affected by AMD will be increasing in future. Healthcare policy makers should be advised to provide more efficient eye care services and preventive strategies in this regard.

INTRAVITREAL INJECTION OF PROPRANOLOL FOR THE TREATMENT OF RETINAL CAPILLARY HEMANGIOMA IN A CASE OF VON HIPPEL-LINDAU.

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of intravitreal propranolol for the management of retinal capillary hemangioma in a patient with Von Hippel-Lindau. METHODS: Two intravitreal injections of 50 µg/0.05 mL propranolol were administered 6 weeks apart in the left eye of a 26-year-old patient with bilateral multiple retinal capillary hemangiomas. Safety and response to therapy were evaluated using electroretinogram, fluorescein angiography, and measurement of visual acuity. Laser photocoagulation was performed in the right eye. RESULTS: One month after the second intravitreal injection of propranolol, fluorescein leakage decreased from the tumors located on the optic nerve head and in the inferonasal retinal periphery. Reduction of the retinal capillary hemangioma vascularity and enhancement of its fibrosis associated with the attenuation of the feeder vessel were also observed. Ophthalmic examination showed no adverse effect except for a mild transient vitreous haziness after each injection. Electroretinogram performed 4 weeks after the first injection revealed no retinal toxicity. CONCLUSION: Intravitreal propranolol showed a therapeutic effect on retinal capillary hemangioma with no short-term adverse effects except a mild transient inflammatory response in a patient with Von Hippel-Lindau.

Incidence and risk factors of retinopathy of prematurity and utility of the national screening criteria in a tertiary center in Iran.

AIM: To determine the incidence and risk factors of retinopathy of prematurity (ROP) and the sensitivity of current screening criteria in a tertiary eye center in Tehran, Iran. METHODS: In a cross-sectional observational study, neonates weighing ≤2000 grams at birth or born <34wk gestational age (GA) and all other infants at risk of ROP admitted to the neonatal intensive care unit (NICU) or referred to our ROP clinic were investigated. The incidence of ROP and severe ROP (i.e. patients needing treatment) were determined. The associations between risk factors and the development and severity of ROP were assessed. We also examined the sensitivity of the current national screening guideline in Iran. RESULTS: Among 207 infants, the incidence of ROP and severe ROP was 33.3% and 11.1%, respectively. Mean GA and birth weight (BW) were significantly lower in ROP vs non-ROP infants (29±2wk vs 33±3wk, P<0.001; 1274±489 g vs 1916±550 g, P<0.001, respectively). Univariate analysis displayed significant association between ROP incidence and GA, BW, NICU admission period, blood transfusion, surfactant usage, sepsis, intraventricular hemorrhage and patent ductus arteriosus (P<0.05 for all). BW [relative risk (RR): 0.857 (0.711-0.873), P<0.001], GA [RR: 0.788 (0.711-0.873), P<0.001] and blood transfusion [RR: 1.888 (0.995-3.583), P=0.052] were independent ROP risk factors. The sensitivity of country-specific screening guidelines was 95.7% and 100% for overall and severe ROP detection, respectively. CONCLUSION: ROP incidence is relatively high in Iran. Identifying ROP risk factors results in more accurate screening and reduces the risk of irreversible vision loss. The ROP screening criteria utilized in Iran are efficient at the present time.