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1.
Strabismus ; : 1-7, 2022 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-35822401

RESUMO

To determine the optical coherence tomography angiography (OCTA) parameters including foveal avascular zone (FAZ) and vessel density (VD) in the amblyopic eyes compared with the fellow sound eyes and the eyes of the non-amblyopic subjects. In this case-control study, a total of 23 eyes from unilateral amblyopic children were included as cases. The sound eye of the amblyopic children was considered as the internal control and the right eyes of the non-amblyopic children were considered as the external control. All participants underwent image recording with OCTA. In the present study, an equal number of 23 unilateral amblyopic eyes and 23 right eyes of non-amblyopic age- and sex-matched children were included as the cases and controls, respectively. The average age of participants in the case and controls were 9.86 ± 3.12 and 8.5 ± 2.35 years, respectively. Twelve patients (52.2%) in the case group and 14 subjects (60.9%) in the control group were female. Whole vascular density of the macula in superficial capillary plexuses (SCP) was significantly lower in the external controls compared with the other studied groups (P = .026). However, the VD of the deep capillary plexuses (DCP) was significantly greater in the external controls than cases and internal controls (P= .029). The average FAZ area was 0.26 ± 0.06 mm2 in amblyopic eyes that was significantly higher compared with fellow eyes (0.21 ± 0.07 mm2; P= .022), but it was not different with non-amblyopic eyes (0.22 ± 0.118 mm2). Based on our findings, there were no significant difference in the cases of foveal, parafoveal, and perifoveal in both superficial and deep vascular densities among amblyopic and non-amblyopic eyes, whereas deep whole density of the amblyopic eyes showed lower percent compared to non-amblyopic ones that indicates decrease blood supply of the amblyopic eyes in this region. Additionally, FAZ was larger in amblyopic eyes than internal controls.

2.
Curr HIV Res ; 2022 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-35770404

RESUMO

BACKGROUND: Leukopenia, a rare adverse effect of Fingolimod therapy, paves the way for opportunistic infections. In this study, we reported a rare fingolimod associated cryptococcal meningitis. CASE PRESENTATION: A 39-year-old woman with RRMS was referred to the emergency department. The patient's major complaints were headache, fever, weakness, and progressive loss of consciousness within the last two days prior to the referral. The patient had history of hospitalization due to RRMS [two times]. In the second hospitalization, interferon Beta-1a had been replaced with Fingolimod. Using polymerase chain reaction, Cryptococcus neoformans was detected in CSF. Liposomal amphotericin B and fluconazole [800 mg per day] were started. Six weeks later, the patient was discharged without any major complaints. CONCLUSION: Albeit fingolimod associated cryptococcal meningitis is a rare event, Fingolimod therapy in patients with MS should be performed cautiously. Regular follow-ups may give rise to a timely diagnosis of probable fingolimod associated cryptococcal meningitis. Fingolimod therapy can lead to lymphocytopenia and various infections. We; therefore, suggest that intermittent blood lymphocyte counts as well as monitoring of clinical manifestations among MS patients treated with Fingolimod to avoid additional neurological and physical disabilities in these patients.

3.
Int J Retina Vitreous ; 8(1): 37, 2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35690809

RESUMO

BACKGROUND: To investigate the adjunctive effect of an intravitreal ROCK inhibitor (fasudil) in combination with intravitreal bevacizumab (IVB) on refractory macular edema secondary to retinal vein occlusion (RVO). METHODS: In this prospective interventional case series, 17 eyes of 17 patients (10 men, 7 women) with refractory RVO-related macular edema underwent three consecutive intravitreal injections of bevacizumab plus fasudil. Monthly evaluation was continued up to 12 months and IVB injection was performed if needed during the follow-up. Changes in the best corrected visual acuity (BCVA) was the primary outcome measure. The secondary outcome measures included central macular thickness (CMT) changes and any adverse events. RESULTS: BCVA significantly improved (mean change: -0.15 LogMAR; P = 0.017) after 3 consecutive intravitreal injections of fasudil in combination with bevacizumab. CMT significantly decreased (mean change: -206 µm; P = 0.028). The anatomical and functional improvement was maintained during the 12 month follow-up. No adverse effects were noticed. CONCLUSION: Intravitreal ROCK inhibitors may break the resistance to anti-VEGF therapy and improve the RVO induced macular edema via affecting the VEGF-independent pathways.

4.
Retina ; 42(6): 1065-1076, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35594075

RESUMO

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.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/cirurgia , Humanos , Injeções Intravítreas , Fotocoagulação a Laser/métodos , Edema Macular/tratamento farmacológico , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual
5.
Retina ; 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34954779

RESUMO

PURPOSE: To present a new technique, RONA, for internal limiting membrane (ILM) peeling and show its comparable success rate in closure of large full thickness macular holes (FTMHs). METHODS: This prospective interventional case series was implemented from January 2018 to November 2019. Consecutive cases with large FTMH with an aperture size of more than 500 µm were included. RONA technique was used to make consecutive flaps; central border of which remained adherent to the FTMH edge. The emphasis is that the central border of all flaps should remain adherent to the FTMH edge, letting the flaps remain there spontaneously. RESULTS: Seventeen eyes of 17 patients (4 males and 13 females; age 62.3 ± 7.8) were included. The mean size of opening and base of FTMH were 651.1 ± 141.1 µm (range: 501 - 950) and 964.6 ± 383.8 µm (range: 527 - 2098), respectively. One week after the surgery, complete closure of all FTMHs occurred with no hole reopening until the end of month 12. Mean BCVA at baseline and twelve months after surgery were 1.57 ± 0.30 logMAR and 0.75 ± .028 logMAR, respectively with statistically significant improvement (P<0.001). CONCLUSION: The first advantage of this efficacious technique is that there is no need to manipulate FTMH edge or underneath tissues. Another and of course, the most important advantage of this technique over others is that there is no need to care about flap unfolding during the exchange stage.

6.
J Ophthalmol ; 2021: 9877205, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34691774

RESUMO

PURPOSE: To evaluate the retinal vascular response to hyperoxia in patients with diabetes at the preclinical stage of diabetic retinopathy (DR) and to quantify the changes in comparison with normal subjects using optical coherence tomography angiography (OCTA). METHODS: In this prospective study, 40 eyes of 20 participants comprising 10 diabetic patients with no diabetic retinopathy (NDR) and 10 normal subjects were recruited. OCTA images were acquired in the resting position and were repeated after a hyperoxic challenge using a nasal mask connected to a reservoir bag supplying 100% oxygen at the rate of 15 L per minute for 5 minutes. The changes of mean parafoveal vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the foveal avascular zone (FAZ) size, and the outer retina flow index were compared between two conditions in each group and between the two study groups. The statistical significance of differences in the means was evaluated using Student's t-test for unpaired samples with consideration of the generalized estimating equations (GEE) for intereye correlation. RESULTS: At baseline, the mean parafoveal VD of SCP and DCP were significantly lower in the NDR participants compared to the healthy subjects (P < 0.001 and P = 0.006, respectively). After induction of the hyperoxic challenge in healthy participants, mean parafoveal VD reduced at both the SCP and DCP, but reached a statistical significance only in DCP (P = 0.006). However, following induction of hyperoxic challenge in patients with NDR, no significant decline was noticed in mean parafoveal VD of SCP and DCP. The degree of change in mean parafoveal VD of DCP was statistically significantly more pronounced in healthy subjects compared to the NDR group (P = 0.034). The change in FAZ size and the outer retina flow index were comparable between the two study groups. CONCLUSION: Retinal capillary layers responded differently to hyperoxia-induced challenge, and in normal subjects, the autoregulatory mechanism was mostly effective in the parafoveal DCP. Retinal vascular reactivity was impaired in SCP and DCP at the preclinical stage of DR. OCTA as a noninvasive modality was able to quantify the retinal vascular response to the hyperoxic challenge.

7.
J Ophthalmic Vis Res ; 16(3): 415-431, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34394871

RESUMO

Sturge-Weber syndrome (SWS) or encephalotrigeminal angiomatosis is a non-inherited congenital disorder characterized by neurologic, skin, and ocular abnormalities. A somatic activating mutation (R183Q) in the GNAQ gene during early embryogenesis has been recently recognized as the etiology of vascular abnormalities in SWS. Approximately, half of the patients with SWS manifest ocular involvement including glaucoma as the most common ocular abnormality followed by choroidal hemangioma (CH). The underlying pathophysiology of glaucoma in SWS has not been completely understood yet. Early onset glaucoma comprising 60% of SWS glaucoma have lower success rates after medical and surgical treatments compared with primary congenital glaucoma. Primary angle surgery is associated with modest success in the early onset SWS glaucoma while the success rate significantly decreases in late onset glaucoma. Filtration surgery is associated with a higher risk of intraoperative and postoperative choroidal effusion and suprachoroidal hemorrhage. CH is reported in 40-50% of SWS patients. The goal of treatment in patients with CH is to induce involution of the hemangioma, with reduction of subretinal and intraretinal fluid and minimal damage to the neurosensory retina. The decision for treating diffuse CHs highly depends on the patient's visual acuity, the need for glaucoma surgery, the presence of subretinal fluid (SRF), its chronicity, and the potential for visual recovery.

8.
J Curr Ophthalmol ; 33(2): 189-196, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34409231

RESUMO

PURPOSE: To investigate the retinal vascular characteristics among patients with different types of inherited retinal dystrophies (IRDs). METHODS: This comparative cross-sectional study was conducted on 59 genetically confirmed cases of IRD including 37 patients with retinitis pigmentosa (RP) (74 eyes), 13 patients with Stargardt disease (STGD) (26 eyes), and 9 patients with cone-rod dystrophy (CRD) (18 eyes). Both eyes of 50 age- and sex-matched healthy individuals were investigated as controls. All participants underwent optical coherence tomography angiography to investigate the vascular densities (VDs) of superficial and deep capillary plexus (SCP and DCP) as well as foveal avascular zone area. RESULTS: In RP, significantly lower VD in whole image (P = 0.001 for DCP), fovea (P = 0.038 for SCP), parafovea (P < 0.001 for SCP and DCP), and perifovea (P < 0.001 for SCP and DCP) was observed compared to controls. In STGD, VD of parafovea (P = 0.012 for SCP and P = 0.001 for DCP) and fovea (P = 0.016 for DCP) was significantly lower than controls. In CRD, the VD of parafovea (P = 0.025 for DCP) was significantly lower than controls. Whole image density was significantly lower in RP compared to STGD (P < 0.001 for SCP) and CRD (P = 0.037 for SCP). VD in parafovea (P = 0.005 for SCP) and perifovea (P < 0.001 for SCP and DCP) regions was significantly lower in RP compared with STGD. Also, foveal VD in STGD was significantly lower than RP (P = 0.023 for DCP). CONCLUSION: Our study demonstrated lower VDs in three different IRDs including RP, STGD, and CRD compared to healthy controls. Changes were more dominant in RP patients.

9.
Exp Eye Res ; 208: 108622, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34022176

RESUMO

Connective tissue growth factor (CTGF) is released by retinal pigment epithelial (RPE) cells and detectable in proliferative membranes (PrMs). This experimental study was performed to investigate the mRNA and protein levels of both CTGF and vascular endothelial growth factor A (VEGF-A) in a rabbit model of proliferative vitreoretinopathy (PVR). In addition, the effects of a single intravitreal injection of the safe dose of anti-CTGF or bevacizumab as monotherapy and in combination were evaluated. PVR was induced in the right eye of albino rabbits by intravitreal injection of cultured adult human RPE cells. Quantitative real-time reverse transcription PCR (qRT-PCR) and Western blot analysis of CTGF and VEGF-A were performed on whole eye tissue in the PVR model versus controls at different time points. In the next step, the PVR models were assigned to five groups. The monotherapy groups received a single intravitreal injection of 0.1 ml of anti-CTGF 100 µg/ml (final concentration of 6.6 µg/ml in the vitreous) or 0.03 ml of 25 mg/ml bevacizumab. In the combined group, the abovementioned amounts of anti-CTGF and bevacizumab were injected intravitreally from separate sites in one session. No antibody injection was performed in the control group. Intravitreal injection of 0.1 ml of control IgG (1 mg/ml of isotype matched) antibody was performed in the placebo group. After 2 weeks, histologic evaluation including, trichrome staining for collagen, immunostaining by anti-alpha-smooth muscle actin for myofibroblasts, and anti-collagen type-1 antibody on paraffin embedded anterior-posterior sections was done. In addition, fundus photography was performed for clinically equivalent PVR staging. Twenty-four hours following PVR induction, CTGF mRNA and protein levels increased five- and- three-fold compared to controls, respectively (P < 0.001). VEGF-A mRNA and protein levels decreased significantly after 72 h of PVR induction compared to controls (P < 0.05). Means of PrM thickness and myofibroblast cell counts significantly decreased in the anti-CTGF group (P < 0.001 and P < 0.05, respectively). The mean area of collagen type-1 fibers of PrM in the mono- and combination therapy groups that received intravitreal anti-CTGF was significantly reduced (P < 0.001); in addition, mild PVR (stage-1 and 2) formation occurred in comparison with moderate to severe PVR (stage-4 and higher) in other groups. In conclusion, we found that intravitreal injection of CTGF neutralizing antibody resulted in a reduction in PrM thickness, collagen fibers and myofibroblast density in the PVR model. CTGF inhibition may represent a potential therapeutic target for PVR.


Assuntos
Anticorpos Neutralizantes/administração & dosagem , Bevacizumab/administração & dosagem , Fator de Crescimento do Tecido Conjuntivo/administração & dosagem , Epitélio Pigmentado da Retina/efeitos dos fármacos , Vitreorretinopatia Proliferativa/prevenção & controle , Adulto , Inibidores da Angiogênese/administração & dosagem , Animais , Células Cultivadas , Fator de Crescimento do Tecido Conjuntivo/imunologia , Modelos Animais de Doenças , Quimioterapia Combinada , Feminino , Humanos , Imuno-Histoquímica , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Coelhos , Epitélio Pigmentado da Retina/metabolismo , Epitélio Pigmentado da Retina/patologia , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Vitreorretinopatia Proliferativa/diagnóstico , Vitreorretinopatia Proliferativa/metabolismo
10.
Rom J Intern Med ; 59(2): 174-179, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33565300

RESUMO

Background and aims. Approximately 10-30% of the patients with typical symptoms of angina pectoris have normal angiography showing normal macrovasculature. In these patients, however, the microvascular problems should be monitored. Hence, the main aim of this study is to evaluate retinal changes in normal angiographic patients.Methods. In this descriptive cross-sectional study, 60 normal angiographic patients with typical chest pain or anginal equivalents visiting Modarres Hospital Cardiology Research Center between 2018 and 2019 were enrolled and retinal changes were determined in Labbafinejad Hospital by Optical Coherence Tomography Angiography using Foveal Avascular Zone (FAZ), Superficial Vascular Density (SVD), and Deep Vascular Density (DVD).Results. The results of this study demonstrated that FAZ was normal in all subjects, but SVD and DVD were abnormal in 45% and 8.3%, respectively. Totally, 18.5% and 66.7% showed abnormal SVD among stable angina (SA) and unstable angina (UA) cases, respectively (P < 0.001). There was no statistically significant difference between abnormal DVD in SA and UA cases (P = 0.058). Abnormal SVD was significantly more common among diabetic patients (P < 0.001), while DVD was not related to diabetes presence in the study population (P > 0.05). Moreover, abnormal SVD was more common among patients with chest pain (P = 0.036), while there was no significant difference for DVD (P = 0.371). Interestingly, abnormal ECG was associated with both abnormal DVD and SVD.Conclusions. The results of this study showed that nearly half of the patients with angina pectoris or anginal equivalents who revealed normal angiographic findings may suffer from retinal changes. Thus, retinal assessment is needed in these patients to evaluate microvascular changes.


Assuntos
Angina Pectoris/diagnóstico por imagem , Angiografia Coronária , Vasos Retinianos/diagnóstico por imagem , Idoso , Angina Pectoris/fisiopatologia , Estudos Transversais , Eletrocardiografia , Feminino , Humanos , Masculino , Microcirculação , Pessoa de Meia-Idade , Retina/diagnóstico por imagem , Tomografia de Coerência Óptica
11.
Int J Retina Vitreous ; 7(1): 13, 2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33593444

RESUMO

BACKGROUND: To describe the features of multimodal imaging and the diagnostic role of en face OCT in the paracentral acute middle maculopathy (PAMM) spectrum. METHODS: In this observational case series, 5 eyes of 5 patients with acute PAMM were identified. Demographic characteristics as well as data regarding the underlying disease, presenting visual acuity (VA) and ophthalmic examination results were recorded. All patients underwent multimodal imaging within 3 days after symptom onset. RESULTS: The mean age of patients was 52.2 (range, 33-67) years. Systemic comorbidities including diabetes mellitus and hypertension were identified in two patients. Except for one patient diagnosed with isolated PAMM, other patients had signs of retinal vascular disease such as a cilioretinal artery or branch retinal artery obstruction, non-ischemic central retinal vein occlusion, or a combination of these vascular disorders. The central vision was preserved in two cases; however, the remaining cases presented with profound VA reduction. Different patterns of PAMM including arterial, globular, and fern-like were observed in en face OCT at deep capillary plexus (DCP) level. En face OCT images could precisely delineate the margin of the PAMM area. Optical coherence tomography angiography (OCTA) showed decreased vascular density in DCP. Unresolved projection artifact by conventional OCTA software was observed in DCP and choriocapillaris slabs in all cases. CONCLUSION: En face structural OCT in PAMM can delineate the area of ischemia and the degree of foveal involvement. Unresolved projection artifact by conventional OCTA software in the PAMM area can be seen in DCP and choriocapillaris layers.

12.
GMS Ophthalmol Cases ; 10: Doc31, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32884885

RESUMO

Purpose: To present a 65-year-old patient with macular hole (MH) and submacular hemorrhage (SMH) secondary to a ruptured retinal arterial macroaneurysm (RAM) which was successfully treated with a novel surgical technique. Patient: A 65-year-old woman presented with a 1-week history of sudden-onset visual loss in her right eye. Her best-corrected visual acuity (BCVA) was hand motion in the right eye. Her fundus examination revealed intraretinal and massive subretinal hemorrhage with macular involvement. An MH with an approximate diameter of 600 microns was also noted. The patient was treated by a standard pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling, followed by 10 µg recombinant tissue plasminogen activator injection into the submacular space via the MH with a 25-gauge vitrectomy probe. BCVA of the patient increased to 20/320 and 20/60, one and four weeks after surgery, respectively. Optical coherence tomography (OCT) images confirmed the complete anatomical closure of the MH and the restoration of the outer retinal layers such as the external limiting membrane and the ellipsoid zone. Conclusion: This case report expands our knowledge about the management of MH in combination with SMH after a ruptured RAM. We suggest the use of a vitrectomy probe and MH for subretinal recombinant tissue plasminogen activator (rtPA) injection.

13.
Med Phys ; 47(10): 4872-4884, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32609378

RESUMO

PURPOSE: Intra-retinal cyst (IRC) is a symptom of macular disorders that occurs due to retinal blood vessel damage and fluid leakage to the macula area. These abnormalities are efficiently visualized using optical coherence tomography (OCT) imaging. These patients need to be regularly monitored for the presence and changes of IRC regions. Thus, automatic segmentation of IRCs can be beneficial to investigate disease progression. METHODS: In this study, automatic IRC segmentation is accomplished by building three different masks in three unsupervised segmentation levels of a hierarchical framework. In the first level, the ROI-mask (R-mask) is built, and the retina area is cropped based on this mask. In the second level, the prune-mask (P-mask) is built, and the searching space is significantly reduced toward the target objects using this mask; and finally in the third level, by applying the Markov random field (MRF) model and employing intensity and contextual information, the cyst mask (C-mask) is extracted. RESULTS: The proposed method is evaluated on three datasets including OPTIMA, UMN, and KERMANY datasets. The experimental results showed that the proposed method is effective with a mean dice coefficient rate of 0.74, 0.75 and 0.79 by the intersection of ground truths on the OPTIMA, UMN and KERMANY datasets, respectively. CONCLUSION: The proposed method outperforms the state-of-the-art methods on the OPTIMA and UMN datasets while achieving comparable results to the most recently proposed method on the KERMANY dataset.


Assuntos
Cistos , Tomografia de Coerência Óptica , Algoritmos , Cistos/diagnóstico por imagem , Humanos , Retina/diagnóstico por imagem , Vasos Retinianos
15.
Ophthalmic Epidemiol ; 27(3): 209-218, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31960781

RESUMO

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.


Assuntos
Técnicas de Diagnóstico Oftalmológico/instrumentação , Degeneração Macular/diagnóstico , Degeneração Macular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Estudos Transversais , Feminino , Fundo de Olho , Humanos , Hiperopia/epidemiologia , Irã (Geográfico)/epidemiologia , Degeneração Macular/classificação , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Inquéritos e Questionários , Acuidade Visual/fisiologia
16.
Retina ; 40(6): 1110-1117, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31157710

RESUMO

PURPOSE: To investigate the effects of peripheral ischemic retinal photocoagulation in addition to intravitreal bevacizumab (IVB) in the treatment of macular edema due to ischemic central retinal vein occlusion. METHODS: Forty-eight eyes of 48 treatment-naive patients were randomly selected and divided into 2 groups. Group A comprised 24 eyes that were treated with three consecutive monthly injections of IVB, and Group B comprised 24 eyes that were treated with IVB plus photocoagulation of the peripheral nonperfused retina. Further IVB injections were administered as needed in both groups. Monthly follow-up was conducted for 9 months after the first injection. RESULTS: The data of 46 patients were analyzed. Best-corrected visual acuity changes from the fourth to eighth month follow-up in comparison with the baseline were significantly higher in Group B (P = 0.002-0.044-0.002-0.002-0.012). In addition, significant differences were observed in central macular thickness in Group B throughout the study period (all P < 0.001). Group B required less frequent IVB injections during the 9-month study period. CONCLUSION: Photocoagulation of the retinal nonperfused area in patients with macular edema because of central retinal vein occlusion might amplify the beneficial effects of IVB on best-corrected visual acuity and central macular thickness and reduce the frequency of IVB injection.


Assuntos
Bevacizumab/administração & dosagem , Fotocoagulação a Laser/métodos , Edema Macular/terapia , Oclusão da Veia Retiniana/complicações , Acuidade Visual , Adulto , Idoso , Inibidores da Angiogênese/administração & dosagem , Método Duplo-Cego , Feminino , Angiofluoresceinografia/métodos , Seguimentos , Fundo de Olho , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/tratamento farmacológico , Tomografia de Coerência Óptica/métodos
17.
Ophthalmologica ; 242(2): 113-117, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163427

RESUMO

PURPOSE: To evaluate the effects of repeated intra-silicone oil (SO) injections of methotrexate (MTX) on the outcomes of surgery for rhegmatogenous retinal detachment (RRD) with grade C proliferative vitreoretinopathy (PVR-C). METHODS: In this prospective pilot case series, eyes with RRD and PVR-C underwent pars plana vitrectomy and intraocular injection of SO. At the conclusion of the procedure, 250 µg of MTX was injected into the SO-filled vitreous cavity. Intra-SO injection was repeated at weeks 3 and 6; the minimum follow-up period was 6 months. The main outcome measure was retinal reattachment rate. RESULTS: Eleven eyes of 11 patients (mean age, 52.73 ± 18.01 years) were included. The mean follow-up period was 9 ± 3 months (range, 6-15 months). Total retinal detachment with anterior and/or posterior PVR-C was present in all eyes before surgery. Mean preoperative best-corrected visual acuity (BCVA) was 2.62 ± 0.04 logMAR. All operated eyes exhibited retinal reattachment posterior to the equator during the follow-up period. Mean postoperative BCVA was significantly improved to 1.02 ± 0.51 logMAR (p = 0.003). No ocular or systemic side effects were observed. CONCLUSION: Repeated intra-SO injection of MTX as an adjunctive therapy for RRD complicated by PVR showed promising results and was not associated with adverse effects. Further studies are needed to confirm its possible beneficial effects on the final anatomic and functional outcomes in these cases.


Assuntos
Metotrexato/administração & dosagem , Descolamento Retiniano/terapia , Óleos de Silicone , Acuidade Visual , Vitrectomia/métodos , Vitreorretinopatia Proliferativa/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tamponamento Interno , Feminino , Humanos , Imunossupressores/administração & dosagem , Injeções Intraoculares , Fotocoagulação a Laser , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Retina/patologia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Tomografia de Coerência Óptica , Resultado do Tratamento , Vitreorretinopatia Proliferativa/complicações , Vitreorretinopatia Proliferativa/diagnóstico , Adulto Jovem
18.
J Ophthalmol ; 2019: 2073679, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30949361

RESUMO

Purpose: To model a community-based telescreening program for diabetic retinopathy (DR) in Iran and to implement a pilot project at the Iranian Diabetes Society (IDS) branch in a Tehran suburb. Methods: In this mixed model study, a web application called the "Iranian Retinopathy Teleophthalmology Screening (IRTOS)" was launched. The educational course for DR screening was established for general practitioners (GPs). Registered patients in IDS branch were recalled for fundus photography; images were transferred to the reading center via IRTOS to be graded by GPs, and patients were informed about the results via mobile messaging. All images were independently reviewed by a retina specialist as the gold standard. Patients who required further assessment were referred to an eye hospital. Results: Overall, 604 subjects with diabetes were screened; of these, 50% required referral. The sensitivity and specificity for diagnosis of any stage of DR by trained GPs were 82.8% and 86.2%, respectively, in comparison to the gold standard. The corresponding values for detecting any stage of diabetic macular edema (DME) were 63.5% and 96.6%, respectively. Conclusions: Telescreening was an effective method for detecting DR in a Tehran suburb. This screening model demonstrated its capacity for promoting diabetic eye care services at the national level. However, the sensitivity for detecting DME needs to be improved by modifying the referral pathway and promoting the skill of GPs.

19.
J AAPOS ; 23(2): 86.e1-86.e7, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30885809

RESUMO

PURPOSE: To evaluate the effect of a computer-based training program-Massachusetts Eye & Ear ROP Trainer-on residents' knowledge of retinopathy of prematurity (ROP) management. METHODS: In this prospective, randomized study, ophthalmology residents from nine different training programs consented to participate. Those who completed the study were randomly assigned to either the Trainer or the control group. The ROP Trainer was created using clinical cases encompassing the stages of ROP in digital pictures and videos. It includes sections on screening decisions, examination techniques, and diagnosis, and a reference section with the expert video clips and a searchable image library. Subjects in the control group were asked to study standard print material on ROP. A pre- and post-test, consisting of theoretical and practical (diagnosis) questions, and a post-intervention satisfaction test were administered. Accuracy of ROP diagnosis was assessed. RESULTS: A total of 180 residents agreed to participate, of whom 60 completed the study. Residents in the Trainer group had statistically significant improvements (P = 0.003) in ROP knowledge and diagnostic ability (P = 0.005). Residents randomized to the Trainer group were more satisfied with the training materials than were those in the control group. There was no significant difference in improving knowledge by year of training, sex, or country. Considering all training levels, a statistically significant increase was observed in sensitivity for the diagnosis of preplus or worse, zone I or II, ROP stage, category, and aggressive posterior ROP in the Trainer group. CONCLUSIONS: In this study, the Trainer was shown to significantly improve ROP knowledge and diagnostic skills of residents, regardless of sex, year, of training, or country.


Assuntos
Competência Clínica/normas , Instrução por Computador/métodos , Internato e Residência/métodos , Oftalmologia/educação , Retinopatia da Prematuridade/diagnóstico , Retroalimentação , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Massachusetts , Oftalmologia/normas , Estudos Prospectivos , Retinopatia da Prematuridade/terapia
20.
Br J Ophthalmol ; 103(7): 922-927, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30150280

RESUMO

Click here to listen to the Podcast BACKGROUND/AIMS: To compare the efficacy of combined intravitreal injection of bevacizumab and a Rho-kinase inhibitor, fasudil (intravitreal bevacizumab (IVB)/intravitreal fasudil (IVF)), with IVB alone for centre-involving diabetic macular oedema (DME). METHODS: In this prospective randomised clinical trial, 44 eyes with centre-involving DME were randomised into two groups. The combined group received three consecutive injections of IVB (1.25 mg) and IVF (50 µM/L) monthly, while the monotherapy group received only one IVB (1.25 mg) injection per month for 3 months. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were compared between the two groups at months 3 and 6. The primary outcome measure was the mean change in BCVA at month 6. RESULTS: Mean BCVA was significantly improved in both groups at month 3 (P<0.001), but it persisted up to month 6 only in the IVB/IVF group. Improvement of BCVA was greater in the IVB/IVF group at both time points (P=0.008, P<0.001). In the IVB/IVF and IVB groups, 54.5% versus 10% of the eyes gained≥15 ETDRS letters at month 6 (P=0.026). Between months 3 and 6, mean BCVA significantly decreased by 5±7 ETDRS letters in the IVB group (P=0.002), while no significant deterioration was observed in the IVB/IVF group. Corresponding with the BCVA changes, CMT was significantly reduced in both groups at month 3 (p=0.006, p<0.001) but this reduction sustained only in the IVB/IVF group up to month 6 (p<0.001). CONCLUSION: Adjunctive intravitreal injection of a Rho-kinase inhibitor may enhance and prolong the therapeutic effects of anti-vascular endothelial growth factor drugs for centre- involving DME.


Assuntos
1-(5-Isoquinolinasulfonil)-2-Metilpiperazina/análogos & derivados , Bevacizumab/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Macula Lutea/patologia , Edema Macular/tratamento farmacológico , Acuidade Visual , 1-(5-Isoquinolinasulfonil)-2-Metilpiperazina/administração & dosagem , Adulto , Idoso , Inibidores da Angiogênese/administração & dosagem , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Angiofluoresceinografia/métodos , Seguimentos , Fundo de Olho , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Inibidores de Proteínas Quinases/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Tomografia de Coerência Óptica , Resultado do Tratamento
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