Intravitreal Injection of Bevacizumab in Primary Vitrectomy to Decrease the Rate of Retinal Redetachment: A Randomized Pilot Study.

PURPOSE: To evaluate the effect of intravitreal bevacizumab (IVB) as a surgical adjunct in prevention of proliferative vitreoretinopathy (PVR) after retinal detachment surgery. METHODS: In this controlled, randomized pilot study, 27 patients with primary retinal detachment undergoing pars plana deep vitrectomy were included. Of these, 12 received IVB at the end of procedure. The anatomic success and best corrected visual acuity (BCVA) were compared to the control group at months 3 and 6 postoperatively. RESULTS: At three month follow-up, 3 of 11 eyes (27.3%) had detached retinas in the IVB group versus 6 of 12 (50.0%) in the control group (P = 0.40). At six-month follow-up, 3 of 10 eyes (30%) had detached retinas in the IVB group versus 3 in 8 (37.5%) in the control group (P > 0.99). Mean logMAR BCVA improved significantly in both groups relative to baseline, but did not show a significant difference at three-and six-month follow-ups between the two groups. CONCLUSION: Our preliminary results show neither a benefit nor any harm from intervention in both anatomic and visual outcomes. Our results support conducting additional studies to evaluate the effect of intravitreal bevacizumab on postoperative PVR.

Intravitreal Topotecan Inhibits Laser-induced Choroidal Neovascularization in a Rat Model.

PURPOSE: A two-phase preclinical study was designed to determine the safe dose of intravitreal topotecan and its inhibitory effect on experimental choroidal neovascularization (CNV) in a rat model. METHODS: In phase I, 42 rats were categorized into 6 groups, 5 of which received intravitreal topotecan injections of 0.125 µg, 0.25 µg, 0.5 µg, 0.75 µg, and 1.0 µg/5 µl, respectively; the control group received an injection of normal saline. Ophthalmic examination and electroretinography (ERG) were performed on days 7 and 28, and enucleated globes were processed for histopathology and immunostaining for glial fibrillary acidic protein. In phase II, CNV was induced via laser burns in 20 rats and the animals were divided into 2 groups. One group received topotecan and the other received normal saline intravitreally. Four weeks later, mean scores of fluorescein leakage on fluorescein angiography as well as mean CNV areas on histology sections were compared. RESULTS: In phase I, clinical, ERG and histopathologic results were unremarkable in terms of retinal toxicity in all groups. Based on the results of phase I, a dose of 1 µg/5 µl topotecan was chosen for phase II. Leakage scores obtained from late-phase fluorescein angiography were significantly lower in topotecan-treated than control eyes (P < 0.01) four weeks after induction of CNV. Compared to control eyes, topotecan-treated eyes showed a significantly lower incidence of fibrovascular proliferation (8.7% vs. 96.2%) and significantly smaller areas of CNV (P < 0.01). CONCLUSION: Intravitreal injection of topotecan at a dose of 1 µg/5 µl is safe and may be a promising treatment for CNV.

Uveitis profile and treatment response in Iranian patients with sarcoidosis.

The aim of the study was to assess the clinical features and treatment responses in Iranian patients with sarcoid uveitis. A retrospective review of patients diagnosed with sarcoid uveitis from 1996 to 2010 was performed in a referral clinic in Tehran, Iran. Demographic and clinical features of patients, treatment modalities and therapeutic responses, and outcomes were recorded. Sixty-six eyes from 36 patients were studied. Twenty cases had biopsy-proven sarcoidosis. Mean duration of follow-up was 44.7 ± 45 months (range 3-175). Thirty-six eyes (54.5 %) had intermediate uveitis, 25 (37.9 %) panuveitis, and 5 (7.6 %) anterior uveitis. Twenty patients (55.5 %) responded to both systemic and/or topical corticosteroids, and 16 (44.4 %) required immunomodulatory drugs for control of uveitis. All of the patients finally responded to treatment in the form of inflammation reduction and/or vision improvement. The average time interval before initial clinical response following treatment was 3.2 ± 3 months (range 1-72). This study disclosed a higher predominance of females and intermediate form of uveitis in Iranian patients with sarcoid uveitis. Use of immunomodulatory drugs combined with corticosteroids resulted in good visual outcome and control of uveitis with a possible fewer corticosteroid side effects.

Sensorineural hearing loss in pseudoexfoliation syndrome.

PURPOSE: To determine hearing thresholds at sound frequencies important for speech comprehension in subjects with ocular pseudoexfoliation and to compare them with that of age- and sex-matched controls without pseudoexfoliation. DESIGN: Case-control study. PARTICIPANTS: Eighty-three subjects with ocular pseudoexfoliation and 83 age- and gender-matched controls without pseudoexfoliation. METHODS: Pure tone audiometry (air and bone conduction) was performed at 1, 2, and 3 kilohertzes in all subjects. Hearing thresholds were compared with an age- and gender-stratified standard (ISO7029) and between study groups. MAIN OUTCOME MEASURES: Individual hearing thresholds at 1, 2, and 3 kilohertz and hearing loss, defined as the sum of tested thresholds lower than the ISO7029 standard median. RESULTS: A total of 166 eligible subjects were evaluated. Equal numbers of male and female subjects were allocated into each of the study groups (60 male and 23 female subjects in either group). Mean ages of male and female participants did not significantly differ in cases versus controls (P = 0.88 and P = 0.83). Below average hearing thresholds were present in 88.4% of examined ears in the case group, versus 53.6% in the control group (P<0.001; odds ratio [OR], 6.69; 95% confidence interval [CI], 3.49-11.79). Overall, 78 subjects (94.0%) in the case group, versus 58 subjects (69.9%) in the control group, had below average hearing in one or both ears (P<0.001; OR, 6.72; 95% CI, 2.42-18.62). Hearing thresholds at each of the examined frequencies and the total threshold were also significantly higher in individuals with pseudoexfoliation. Although glaucoma was significantly more common in subjects with pseudoexfoliation, it was not associated with below average hearing in any of the study groups. CONCLUSIONS: Hearing thresholds at frequencies that are important for speech comprehension are significantly worse in individuals with ocular pseudoexfoliation than in matched controls. This finding may support the multiorgan nature of pseudoexfoliation syndrome.