Effect of sodium chloride as a porogen agent in mechanical properties of PLGA/HA nanocomposite scaffolds.

In this study, the novel poly (lactic-co-glycolic acid)-Hydroxyapatite nanoparticles (PLGA/HA) nanocomposite scaffolds were fabricated with solvent casting and particulate leaching (SCPL) method. The role of sodium chloride (NaCl) particles with diameters of 250-400 µm as porogen agent in the mechanical strength of the produced scaffolds was evaluated. The prepared scaffolds were characterized using Fourier transform infrared (FT-IR), X-ray diffraction (XRD), scanning electron microscopy (SEM), thermal gravimetric analysis (TGA) and compressive tests. The results showed the high compressive strength and homogenous porous structures for PLGA/HA nanocomposite scaffolds compared to pure PLGA due to the presence of HA nanoparticles in nanocomposites. Furthermore, the compressive strength of nanocomposite scaffolds increased by varying the weight ratio of hydroxyapatite nanoparticles to polymer (0, 20, 40 wt%) at constant salt ratio and decreased by increasing the weight ratio of salt particles to polymer from 1 to 3 wt% due to more porosity in nanocomposite scaffolds. These results confirmed that not only the nanocomposite scaffolds exhibited high mechanical properties, homogenous structures, as well as good porosity but also, they could be useful for bone tissue application.

Outcome of surgery in patients with giant retinal tear: 10 years experience.

PurposeTo present our experience with the surgery in retinal detachment (RD) associated with giant retinal tear (GRT) over 10 years in a tertiary referral hospital.Patients and MethodsIn this retrospective study, the charts of all patients with the diagnosis of RD associated with GRT who underwent surgery from 2005 to 2015 at Rassoul Akram Hospital were reviewed. Exclusion criteria were concomitant presence of diabetic retinopathy, and uveitis. All patients had to have at least 3 months of follow up. The success rate and factors associated with repeated surgery were determined.ResultsSixty two eyes of 61 patients including 51 males and 10 females were assessed. Proliferative vitreoretinopathy (PVR) was present in 14 (22.6%) of eyes. Pars plana vitrectomy (PPV) alone was performed in 44 eye (71.0%) and simultaneous vitrectomy and phacoemulsification surgery was performed in 18 eyes (29.0%). An encircling episcleral band was placed in 7 eyes (11.3%). Anatomic success after one vitrectomy procedure was achieved in 45 eyes (72.58%) and ultimately in 61 eyes (98.4%) at last follow up. Seventeen eyes needed repeated PPV due to redetachment associated with PVR in the follow up period. The rate of repeated PPV was significantly higher in eyes with PVR at baseline and surgery with encircling episcleral band. Trauma, extension of tear, age, and lens status had no significant effect on the rate of repeated PPV.ConclusionsOur study shows that the high surgical success can be achieved in patients with RD associated with GRT with single or multiple surgeries.

Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy.

PURPOSE: To evaluate the role of methotrexate (MTX) injected into the silicone oil at the end of pars plana vitrectomy for advanced proliferative diabetic retinopathy (PDR). METHODS: In this prospective comparative interventional study, eyes with severe diabetic tractional macular detachment or combined tractional/rhegmatogenous retinal detachment were included. Standard 20 gauge pars plana vitrectomy, and retinal reattachment was performed. In the case group, 250 µg MTX was injected into the silicone oil at the end of surgery. The rate of retinal re-detachment associated with fibrovascular proliferation or proliferative vitreoretinopathy (PVR) was assessed. RESULTS: Overall, 38 eyes of 35 patients (19 cases and 19 controls) were studied. The two groups were matched for age, sex, preoperative visual acuity, and the type of surgery (vitrectomy alone vs combined phacoemulsification/vitrectomy). Retinal re-detachment with fibrovascular proliferation or PVR occurred in seven eyes (36.8%) in the MTX group and eight eyes (42.1%) in the control group (P = 0.74). Mean change in visual acuity was 0.04 ± 0.71 and 0.39 ± 0.70 logMAR in the MTX and the control group, respectively (P = 0.14). The rate of improvement or worsening of visual acuity was similar between the two groups (P = 0.51 and P = 0.12). CONCLUSION: Intra-silicone injection of MTX at the end of vitrectomy for retinal detachment associated with severe PDR did not reduce the risk of postoperative retinal detachment due to the fibrous or fibrovascular proliferations.

Scleral buckling surgery for rhegmatogenous retinal detachment with subretinal proliferation.

PURPOSE: To evaluate the outcome of scleral buckling surgery in patients with rhegmatogenous retinal detachment (RRD) with subretinal proliferation. METHODS: 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. RESULTS: 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 (P<0.001). An improvement in BCVA of >2 lines was found in 23 eyes (52.2%) and worsening of best corrected visual acuity of >2 lines was observed in 2 eyes (4.5%). CONCLUSIONS: Scleral buckling surgery is highly successful in eyes with RRD associated with subretinal proliferation.

Intrasilicone oil injection of bevacizumab at the end of retinal reattachment surgery for severe proliferative vitreoretinopathy.

PURPOSE: To evaluate the role of bevacizumab injected into the silicone oil at the end of retinal reattachment surgery for rhegmatogenous retinal detachment (RRD) associated with severe proliferative vitreoretinopathy (PVR) for prevention of postoperative PVR and compare the results with those without intrasilicone injection. METHODS: In this prospective comparative interventional study, eyes with RRD with grade C PVR were included. Standard 20 gauge pars plana vitrectomy, and retinal reattachment was performed. In case group, 1.25 mg bevacizumab was injected into the silicone oil at the end of surgery. The rate of retinal redetachment associated with PVR was assessed. RESULTS: In all 38 eyes of 38 patients (19 cases and 19 controls) with a mean age of 46.6 ± 18.3 years were studied. The two groups were matched for age, sex, preoperative visual acuity, presence of anterior and posterior PVR, extent of PVR, and history of previous retinal detachment surgery. Retinal redetachment with PVR occurred in nine (47.3%) and seven (36.8%) eyes in case and control groups, respectively (P=0.5). Extensive subretinal fibrous proliferations in addition to preretinal membranes occurred more in the case group (55.5 vs 14.3%). At final visit, visual acuity was similar between the two groups (1.6 ± 0.8 and 1.6 ± 0.6, respectively, P=0.9). CONCLUSION: Intrasilicone injection of bevacizumab at the end of vitrectomy for RRD with severe PVR does not eliminate the risk of postoperative PVR.

Therapeutic effect of bevacizumab injected into the silicone oil in eyes with neovascular glaucoma after vitrectomy for advanced diabetic retinopathy.

PURPOSE: To evaluate the effect of intra-silicone injection of bevacizumab for the treatment of neovascular glaucoma (NVG) after vitrectomy for advanced proliferative diabetic retinopathy. METHODS: Bevacizumab was injected into the silicone oil in five pseudophakic eyes of five patients with NVG. The iris neovascularization (INV) and NVG had developed 1.5-4 months after vitrectomy and silicone oil tamponade. The main outcome measures were regression of INV, intraocular pressure and visual acuity. RESULTS: In all eyes, INV regressed and intraocular pressure was controlled within 7 days. Visual acuity improved in all eyes. In one patient, INV and NVG recurred 10 weeks after the injection and was successfully treated with a repeat intra-silicone bevacizumab injection. CONCLUSION: Intra-silicone injection of bevacizumab is effective in the treatment of patients with INV and NVG after vitrectomy for advanced proliferative diabetic retinopathy.

Neoadjuvant chemotherapy and radical surgery compared to radical surgery alone in bulky stage IB-IIA cervical cancer.

AIM: The aim of this study was evaluation of the efficacy of neoadjuvant chemotherapy (NACT) and radical hysterectomy on long-term survival in stage IB-IIA locally advanced cervical cancer as compared with radical surgery alone. METHODS: We reviewed all patients with cervical cancer stage IB-IIA who were treated with two treatment modalities, i.e. NACT followed by radical hysterectomy and lymphadenectomy, and radical hysterectomy alone between March 1996 and March 2004. There were 22 patients in the NACT group (group 1) and 160 patients in the immediate radical surgery group (group 2). All patients in group 1 were followed for more than 108months, and long-term survival and factors affecting recurrence were evaluated. RESULTS: Nineteen patients in the NACT arm underwent radical surgery. Pelvic lymph node metastasis was found in 8 patients in this group and in 36 in the radical surgery group. Eighteen patients in the NACT group and 96 patients in the radical surgery group were scheduled for adjuvant postoperative chemoradiation. During the 9-year follow-up, recurrence rate was 47.1% and 30.2% in NACT and control groups, respectively. In the NACT group lymph node metastasis was a significant independent risk factor for recurrence. Overall survival in the NACT arm was not statistically significantly lower than the control arm (p=0.06). CONCLUSION: NACT did not improve long-term overall survival of bulky early-stage cervical cancer patients compared to primary radical surgery.

Accidental subretinal injection of triamcinolone acetonide.

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 inferiorly. Visual acuity in the left eye was 20/400. Subretinal 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.

Inadvertent globe perforation during retrobulbar injection in high myopes.

PURPOSE: To report ocular perforation that occurred during retrobulbar injection in 7 highly myopic eyes. METHODS: Seven patients with a diagnosis of globe injury during retrobulbar injection for ocular anesthesia before cataract surgery were managed by vitreoretinal surgery. All injections were performed by ophthalmologists. The surgeon recognized the perforation in 4 cases at the time of injection. The preoperative vision was hand motion perception in 4 eyes and light perception in 3 eyes. All patients underwent vitreoretinal surgery because of the presence of vitreous hemorrhage and/or retinal detachment diagnosed by funduscopy or ultrasonography. At the time of surgery, all eyes had vitreous hemorrhage and 4 eyes had rhegmatogenous retinal detachment. The number of vitreoretinal procedures performed was: 1 procedure in 4 patients, 2 procedures in 2 patients, and 3 procedures in 1 patient. 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 retina was attached in 6 patients. The postoperative vision was 20/400 in 3 eyes, finger counting in 3 eyes, and light perception in 1 eye. CONCLUSION: Special care should be taken in retrobulbar injection of highly myopic globes, which have an increased risk of perforation. The functional outcome of surgical repair of these eyes was poor.

Prevalence of congenital color deficiencies in secondary-school students in Tehran.

PURPOSE: A population-based study was conducted to determine the prevalence of color deficiencies in secondary-school students (ages 12-14) in Tehran. METHODS: A total of 2,058 students (1,136 males, 922 females) were examined with Ishihara pseudoisochromatic color plates. RESULTS: In the study population, 97 cases of defective color vision were detected, including 93 males and 4 females. The affected individuals all had negative histories of previous systemic and ocular disease or chronic use of medications. The visual acuity was 20/20 and the fundus was normal in all affected students. Of the 93 cases of defective color vision in males (8.18%), 56 cases (4.93%) involved deuteranomaly, 13 (1.14%) protanomaly, 13 (1.14%) deuteranopia, and 11 (0.97%) protanopia. The four cases in females (0.43%) involved deuteranomaly in three cases (0.32%) and protanomaly in 1 case (0.11%). Deuteranopia and protanopia were not detected in females. CONCLUSION: This is the first study to determine the prevalence of congenital color blindness in Iran. The results agree with reports of prevalence of congenital color blindness from Western Europe.