Comparison between bilateral implantation of a trifocal intraocular lens (Alcon Acrysof IQ® PanOptix) and extended depth of focus lens (Tecnis® Symfony® ZXR00 lens).

PURPOSE: To compare the visual performance outcomes following bilateral cataract surgery using trifocal intraocular lens (Alcon Acrysof IQ® PanOptix) and extended depth of focus lens (Tecnis® Symfony® ZXR00 lens). METHODS: In this prospective, non-randomized, comparative trial, a total of 40 subjects (80 eyes) were divided into two different groups and submitted to bilateral cataract surgery and implantation of the two different IOLs, Alcon Acrysof IQ® PanOptix® TNFT00 in group A and Tecnis® Symfony® ZXR00 lens (Johnson & Johnson Vision) in group B, was assessed. The uncorrected and corrected near (33 cm), intermediate (60 cm), and far (4 m) binocular visual acuity was measured, and visual binocular defocus curves were also measured in the photopic condition with a long-distance visual acuity and the qualitative visual function was assessed by NEI VFQ-25. RESULTS: Group A comprised 20 patients; 11 women (55%) and 9 men (45%) with a mean age of 62.1 ± 5.4. In group B 20 patients were recruited; 12 women (60%) and 8 men (40%) with a mean age of 63.2 ± 6.1. The postoperatively calculated mean sphere was + 0.35 ± 0.12 D and - 0.14 ± 0.13 D in groups A and B, respectively. The postoperative uncorrected distance visual acuity (UDVA) as well as uncorrected intermediate visual acuity (UIVA) were statistically equal in both groups (P = 0.12, P = 0.17); meanwhile, the postoperative uncorrected near visual acuity (UNVA) was significantly better in patients with PanOptix IOL implantation (P = 0.01) compared to the binocular defocus curve; the results of the PanOptix group were better than the Symfony group in intermediate and near distance (P = 0.089, P = 0.001) and according to the VFQ-25 questionnaire, then ear vision score as well as sum score turned out to be significantly higher in groups A than B (P = 0.001 and P = 0.015, respectively). CONCLUSION: Both strategies were able to provide good vision for far, intermediate and near distances.

Pneumatic retinopexy for primary repair of rhegmatogenous retinal detachments.

PURPOSE: To evaluate anatomical and functional outcomes of pneumatic retinopexy (PR) for primary repair of rhegmatogenous retinal detachments and to determine demographic and ocular risk factors for failure of the procedure. DESIGN: Retrospective interventional case series. METHODS: A chart review on 97 eyes of 97 consecutive patients who had undergone PR as the initial procedure for unilateral recent primary retinal detachments with causative break(s) in the superior two-third of the retina. After injection of 0.35 mL to 0.60 mL of sulfur hexafluoride, 6 hours face-down positioning, and the steamroller maneuver, the patient's head position was changed so that the gas could efficiently tamponade the retinal break(s). Pre- and post-gas injection laser photocoagulation of break(s) and 360° peripheral retina was applied. RESULTS: Seventy-two male and 25 female patients were included in this study. The single-operation success rate was 82.5%. The pars plana vitrectomy procedure as the second intervention was not adversely affected by the preceding PR. Presence of proliferative vitreoretinopathy (odds ratio: 58.7, 95% confidence interval: 7.8-443.5) and delay between initial symptoms and PR (odds ratio: 1.21 per each additional day, 95% confidence interval: 1.07-1.37) were the only independent predictors for the failure. CONCLUSION: With proper selection of cases, PR is a good surgical option for primary rhegmatogenous retinal detachments with acceptable success rate, minimal discomfort to the patient, and minimal surgical risks.

Effect of anterior chamber air bubble on prevention of experimental Staphylococcus epidermidis endophthalmitis.

BACKGROUND: Bacterial endophthalmitis is a serious complication of penetrating ocular trauma and cataract surgery. The purpose of this study is to assess the ability of an anterior chamber air bubble to prevent experimental Staphylococcus epidermidis endophthalmitis. METHODS: The anterior chamber was opened with a clear corneal incision to drain the aqueous humor in one eye of 24 rabbits. S. epidermidis was injected into the anterior chamber. The infected rabbits were randomly divided into two groups. Animals in group 1 (n = 12) received an air bubble to reconstruct the anterior chamber, and animals in Group 2 (n = 12) received Balanced Salt Solution (BSS) for reconstruction. Clinical examination in each group was performed 2, 3 and 7 days after inoculation of the bacteria. Clinical examination scores were recorded. All eyes were enucleated for histophatological examination. RESULTS: Clinical endophthalmitis was seen in 7/12 (58.3%) in group 2, but in only 1/12 (8.3%) in group 1 (p = 0.027). Mean clinical scores of groups 1and 2 on the 3rd day were 2.6 +/- 1.4 and 7.2 +/- 1.7 respectively. (p < 0.001). The mean clinical scores of groups 1and 2 on the 7th day were 2.3 +/- 1.2 and 6.8 +/- 1.5 respectively (p < 0.001). Histopathological examination confirmed clinical findings. CONCLUSION: An air bubble in the anterior chamber may have protective effects against the development of experimental S. epidermidis endophthalmitis.

Preliminary results of subconjunctival bevacizumab in primary pterygium excision.

PURPOSE: To evaluate the efficacy of subconjunctival bevacizumab as an adjunctive therapy for primary pterygium surgery. MATERIAL AND METHODS: This randomized prospective clinical study was conducted on 30 eyes of 30 patients. After pterygium excision and accomplishing a rotational conjunctival flap, 15 patients (case group) received 1.25 mg (0.1 ml) bevacizumab, and 15 other patients (control group) received 0.1 ml balanced salt solution subconjunctivally. The main outcome measures were recurrence of pterygia, horizontal length of the corneal epithelial defect, conjunctival erythema, lacrimation and photophobia during the first postoperative week. RESULTS: There were no statistically significant differences regarding age, sex or recurrence risk factors between the two groups (p > 0.05). The pterygia resolved in 13 (86.6%) of 15 eyes in both groups, with a recurrence rate of 13.4% during a mean follow-up period of 8 +/- 1.4 months in the case group and 7.4 +/- 1.5 months in the control group (p = 0.2). There were no statistically significant differences regarding reduction in refractive astigmatism, improvement in visual acuity, corneal epithelial defects, conjunctival erythema, lacrimation or photophobia between the case and control groups (p > 0.05). CONCLUSIONS: A single intraoperative subconjunctival bevacizumab injection had no effect on recurrence rate or early postoperative conjunctival erythema, lacrimation, photophobia or healing of corneal epithelial defects following pterygium excision.

Combined phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle closure glaucoma.

The purpose of this study was to evaluate the effectiveness of phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle-closure glaucoma (CACG). Fifty-six eyes of 45 recruited patients were classified into two groups: group 1 had medically controlled CACG (IOP 21 mmHg with maximum tolerated medications) including 21 eyes. All of the patients had at least one quadrant without peripheral anterior synechia in gonioscopy. After phacoemulsification, a viscoelastic agent was used for viscogoniasynecialysis. Success was defined as IOP

Association of TNFA -308 G/A and TNFRI +36 A/G gene polymorphisms with glaucoma.

OBJECTIVE: TNF-alpha is one of the most important factors recognized in the pathogenesis of open-angle glaucoma. Therefore, the association of single nucleotide polymorphisms in the TNFRI gene and the promoter region of the TNFA gene with glaucoma susceptibility was investigated in the present study. METHOD: In total, 223 patients with glaucoma and 202 unrelated controls were genotyped by allele-specific oligonucleotide PCR and PCR- restriction fragment length polymorphism to determine TNFA -308 G/A and TNFRI +36 A/G polymorphisms, respectively. RESULTS: In contrast to TNFRI polymorphisms, the genotypes of TNFA -308 G/A polymorphisms showed a significant difference between patients and controls (p = 0.0025). Of interest, the distribution of TNFA genotypes was significantly different between patients with primary open-angle glaucoma (p = 0.001) or pseudoexfoliative glaucoma (p = 0.001) and controls, while no difference was found when chronic angle-closure glaucoma patients were compared to controls (p = 0.72). CONCLUSION: In line with studies showing the role of TNF-alpha in open-angle glaucoma, the results of the present study showed that inheritance of the high producer TNFA -308 A allele might be a susceptibility factor for the development of open-angle glaucoma.

Intravitreal Injection of Bevacizumab: Review of our previous Experience.

Several ocular and systemic complications have been reported after the bevacizumab intravitreal injection. This study aims at reporting the main indications for the bevacizumab intravitreal injection in our center, the intravitreal injection method in this study, and the incidence of the post-injection complication, such as endophthalmitis.This study is a retrospective review of the consecutive intravitreal bevacizumab (Avastin®) injections for 359 patients between 2011 and 2013 at a single institute (Poostchi Clinic of Ophthalmology). Before the injection, a drop containing 5 mLCiprofloxacin and 5 mL Betadine 10% was applied 3 times at the intervals of 10 min. The eye lashes, upper and lower eyelids, and caruncle were swabbed with Betadine 10% but the lid speculum, drape, and conjunctival washing were not conducted.The patients were followed up 8 weeks after the injection for the evaluation of any complications.In this study, 1376 intravitreal injection of bevacizumab in 479 eyes of 359 patients were enrolled. Among them, 141patients (39.3%) were men and 218 (60.7%) were women. The mean age ( ± SD) of the patients was 61.48 (± 11.21) years. On average, each patient received 3.83 (the range 1-13) injections. The most common indications for the bevacizumab intravitreal injection were diabetic retinopathy, choroidal neovascularization, and central retinal vein occlusion. None of the patients developed endophthalmitis, retinal detachment, or other adverse effects. This study showed that the above-mentioned method of the intravitreal bevacizumab injection is easy and safe. The future studies involving more participants are required for the evaluation of rare complications.

The Argus-II Retinal Prosthesis Implantation; From the Global to Local Successful Experience.

Over the past few years, visual prostheses (namely, Argus II retinal implant) and gene therapy have obtained FDA approval in treating blindness resulting from retinitis pigmentosa. Compared to gene therapy; Argus II is less costly with a demonstrated favorable outcome, though the vision is yet artificial. To obtain better results, expectation counseling and preoperative retinal assessment are critical. The global experience with Argus II has enrolled no more than 300 cases so far. The first Argus II retinal prosthesis in Iran was successfully implanted in Shiraz (October 2017). To date, Argus II artificial retina is implanted in four patients in Iran. Beside successful surgery and post-operative care, rehabilitation efforts with validated outcome measures including visual rehabilitation together with neurovisual, visuo-constructive and cognitive rehabilitation/empowerment approaches are expected to boost the functional outcome. A multidisciplinary approach within a cross-functional team would optimize strategies toward better patient outcomes. As such, establishing a collaborative network will foster organized research efforts to better define outcome assessment and rehabilitation strategies. This technology report paper has been an attempt to provide an overview of Argus-II retinal implant global experience as well as the clinical outcome of the so far cases in Iran. Insights from this report were communicated during the first "Brain Engineering and Computational Neuroscience Conference," 31 January-2 February 2018 in Tehran.

Brown syndrome in one pair of dizygotic twins: a case report.

INTRODUCTION: Brown syndrome is a rare ocular movement abnormality. This syndrome is characterized by an inability to elevate the affected eye in adduction. Most cases are sporadic but the occurrence in Monozygotic twins has suggested the possible autosomal dominant inheritance in Brown syndrome. CASE PRESENTATION: A 4-year-old girl (one pair of dizygotic twins) was referred to our pediatric ophthalmology clinic to assess her abnormal eye movement noticed by her mother. Visual acuity of both eyes was 20/20 with Snellen chart. Ocular motility showed mild exotropia in primary position with marked divergence in upward gaze (V pattern), mild hypotropia in adduction, and limitation of elevation in adduction of both eyes (Fig. 1A). We also examined her sister, all ocular evaluations including visual acuity, slit lamp examination, funduscopy and ocular motility (Ductions & Versions) were normal without any limitation. We also review the related articles that previously have reported Brown syndrome in twins. CONCLUSION: Although there are few case reports of Brown syndrome in twins, combination of these reports may elucidate the genetic basis of this disease.

Levodopa-carbidopa may improve vision loss in indirect traumatic optic neuropathy.

To compare the effect of levodopa-carbidopa on the visual outcome of patients with indirect traumatic optic neuropathy (ITON), this randomized, double-blind, placebo-controlled study was conducted on 32 patients with ITON within 6 days after trauma. Patients underwent a complete ocular examination, pattern visual evoked potential (PVEP) testing, and high-resolution orbital computed tomography (CT) scanning. All patients received high-dose intravenous methylprednisolone, and levodopa was also administered to the levodopa group. The main outcome measures were best corrected visual acuity and PVEP results at the last-completed examination. The study was completed on 16 patients in the levodopa group and 10 patients in the placebo group because the others were lost to follow-up. There were no statistically significant differences for age, sex, involved eye, ocular and CT scan findings, pretreatment visual acuity, frequency of recordable PVEPs, and follow-up. In the levodopa group the visual acuity improved significantly after treatment (p = 0.009), but not in the placebo group (p = 0.34). After treatment the visual acuity in the levodopa group was 2.1 ± 2.1, and in the placebo group was 3.9 ± 1.2 (p = 0.008). In those who had visual acuity less than or equal to figure count, significant improvement in visual acuity was observed in the levodopa group (p = 0.03), but not in the placebo group (p = 0.34). However, the final visual acuity in these patients was comparable after treatment (p = 0.21). Nine patients (56.2%) in the levodopa group, and 1 (10%) in the placebo group, experienced improvement in visual acuity (p = 0.02). The frequency of unrecordable PVEPs were comparable in both groups (p = 0.09). Patients treated with levodopa within 6 days of onset of ITON were more likely to experience improvement in visual acuity than those in the placebo group.