mehdi nili ahmadabadi

To evaluate sensitivity and specificity of digital retinal image reading in the diagnosis of referral-warranted retinopathy of prematurity (ROP). Infants referred to the ROP clinic underwent fundus examination through indirect ophthalmoscopy. Fundus photographs were acquired using RetCam (shuttle 2; Clarity medical systems, Pleasanton, CA, USA). Four retinal specialists who were blind to patients' information reviewed the RetCam fundus photographs. By comparing the results of photographs' readings with that of indirect ophthalmoscopy as the gold standard, the sensitivity and specificity of telescreening was determined. A total of 147 treatment-naïve patients met the inclusion criteria and were enrolled in the study. Mean gestational age (GA) was 28.6 ± 2.0 weeks. Digital retinal imaging had sensitivity of 85% and specificity of 35% in detecting referral-warranted ROP in our study. Positive predictive value of digital photography was 80%, and negative predictive value was 43%. Digital photography for diagnosis of ROP may show good potential as a screening modality in developing countries. It can facilitate early diagnosis, prevent unnecessary referrals, and be implemented for investigational purpose. However, the overall study result did not provide evidence to propose digital photography as a substitute for indirect ophthalmoscopy in the diagnosis of ROP.

As an inevitable necessity, continuing education has caught the attention of health policymakers worldwide. Policy making, setting standards, and accreditation of continuing medical education have been endorsed as a law in Iran. The current study aimed to identify how the titles and contents of continuing education conferences are prepared. It also tried to highlight the existing challenges in this field. The qualitative study was performed through in-depth interviews with a wide range of educators, lecturers, and experts of continuing education. Overall, 6 educators, 20 lecturers, and 3 experts of continuing education unit of the Iranian Ministry of Health participated in the study. All educators and lecturers were faculty members. The findings were examined using content analysis. On the whole, the following four domains were extracted: program contents, accreditation, holding programs, and evaluation domains. Not reviewing the titles of programs and employing traditional education techniques were the most important challenges of the process. Therefore, we suggest the establishment of "continuing education needs assessment committees" in universities. Licenses should be granted on the basis of accreditation and needs assessment results. The program titles should be reviewed by specialized councils. The mode of presentation should change from lecturing to combined methods of online tutorials, self-learning, panels, workshops, and case reports. "Continuing education evaluation committees" should be established in universities. Finally, lecturers and educators should be allocated points for promotion and program executives should be financially supported.

To describe the case of a 21-year-old patient with uveal effusion with no microphthalmia and any systemic disease that was treated with scleral window surgery and topical administration of mitomycin C (MMC) and zonulysis which was misdiagnose as a ring melanoma of cilliary body appeared shortly after the operation Case report : A uveal effusion was detected in the eye. Partial-thickness scleral flap with sclerostomy was performed and topical MMC was administered to inferotemporal quadrant of the equatorial sclera. The subretinal fluid resorbed gradually. In a short period after fenestration procedure and temporal zonulysis appeared in the eye. In a patient with idiopathic uveal effusion syndrome, a significant zonulysis without severe intraocular pressure (IOP) changes can appear after scleral fenestration procedure.

To determine the association between retinal vascular diameter and its branching angles with diabetic retinopathy (DR) stages in diabetic patients A descriptive analytic cross-sectional study was conducted in 62 diabetic patients (120 eyes) referred to Farabi Eye Hospital between June 2008 and December 2009. Digital fundus photography pictures were imported into Photoshop software and diameters of arterioles and venules at their second branches from the disc were calculated. Meanwhile branching angles were measured in the same arterioles and venules. DR was graded by retinal specialists according to Airlie House classification of DR. Retinal vascular diameters and their branching angles were compared in different DR stages. There was a significant difference between retinal vascular diameters in different retinopathy stages. The diameter was significantly more in proliferative stage compared with mild nonproliferative stage (P<0.05). After multivariate analysis, age or hypertension has had no effect on the results. However, there was no significant difference between vascular angles in different retinopathy stages (P>0.05). Retinal vascular diameter, but not retinal vascular angle, seems to be related with retinopathy stage regardless of age and hypertention in these patients.

To evaluate the effects of memantine on improving visual function in patients with acute nonarteritic anterior ischemic optic neuropathy (NAION) This was a prospective, double masked, randomized, clinical trial. The study involved 47 subjects with unilateral NAION of less than 8 weeks duration. Eligible patients were randomly allocated to take either memantine tablets (5 mg daily during the first week and then 10 mg daily for the next two weeks, 25 subjects) or placebo tablets (22 subjects). Baseline visual acuity (VA) tests, pattern visual evoked potential (VEP) and automated perimetry (SITA-standard 24-2) were performed. VA tests were repeated 3 weeks, 3 months and 6 months after initial visit. VEP and automated perimetry were repeated 3 months after initial visit. At baseline there was no significant difference between the two groups in terms of clinical and laboratory characteristics. After 3 weeks, 3 months and 6 months of treatment, best corrected visual acuity (BCVA) improved by -0.31±0.39, -0.49±0.47 and -0.53±0.48 logMAR in the memantine group respectively and -0.02±0.41, -0.09±0.60 and -0.05±0.67 logMAR in the placebo group respectively (P=0.024, P=0.025 and P=0.017). VEP results demonstrated a reduction of implicit time of -8.32±17.18 mS in the memantine group after 3 months, whereas in the placebo group it increased +5.7±21.60 mS (P=0.043). The change in VEP amplitude was not significantly different between the memantine and placebo groups (P=0.083). The effect of the memantine on mean deviation (MD) and pattern standard deviation (PSD) changes was not significantly different from that of the placebo (P=0.428 and 0.863 respectively). Treatment of patients who experience acute NAION with memantine may result in significant improvement in BCVA compared with no treatment. The VEP changes seen at 3 months may indicate improved transmission of impulses through the optic nerve.

To compare postoperative anatomical sclerotomy sites of transconjunctival sutureless vitrectomy (TSV) with conventional 20-gauge vitrectomy In this prospective, nonrandomized study 30 consecutive patients divided in 2 groups: group I, 15 eyes from 15 patients underwent conventional 20-gauge and group II, 15 eyes from 15 patients underwent TSV (23, 25-gauge) pars plana vitrectomy (PPV). Wound gap, wound healing, vitreous incarceration and fibrovascular ingrowth (FVIG) at the sites of sclerotomy were assessed using ultrasound biomicroscopy (UBM) at week 8, postoperatively. In group 1 (conventional), healing of infusion cannula, vitrectomy and illuminating sites had occurred in 53.3%, 60% and 66.7% of patients. In group 2 (TSV), healing of infusion cannula, vitrectomy and illuminating sites occurred in 66.7%, 66.7% and 80% of patients. There was no significant difference between the two groups. FVIG was solely observed in diabetic patients in total sclerotomy sites (9 patients, 27 sclerotomy sites in conventional and 8 patients, 24 sites in TSV group). FVIG occurred in 7/27 sites (25.9%) in 20-gauge group and 5/24 sites (20.8%) in TSV group which was not significantly different (P=0.18). Wound gap was not found in any patient of the two groups. The overall comparison of sclerotomy sites (45 sites in each group) showed no significant difference regarding wound healing and vitreous incarceration. No case of ocular hypotony or endophthalmitis was observed at the end of follow-up time. Based on the UBM images of sclerotomy sites, there were no significant differences, in vitreous incarceration, wound healing, wound gap and FVIG between TSV and conventional PPV.

The first report of electroretinographic changes following the intravitreal injection of carboplatin in a patient with retinoblastoma Case report : Recurrent tumors after chemoreduction and adjunctive local treatment in a case of familial unilateral retinoblastoma, group C, was treated with intravitreal carboplatin (10 µg) injections. The tumor was regressed after 3 injections. Flat electeroretinogram (ERG) amplitude was noted following the intravitreal injection of carboplatin. After nearly one year tumor-free period in this case, visual acuity (VA) in the affected eye was 20/800 despite a flat ERG. Intravitreal carboplatin can effectively treat intraretinal tumor recurrences but de-novo tumors can be produced causing therapeutic problems. Intravitreal injections of carboplatin can cause retinal toxicity and flat ERG.

To determine the efficacy of three therapeutic regimens for the treatment of amaurosis fugax secondary to embolic sources from the heart Sixty patients randomly divided into 3 groups (20 patients in each group). Group 1 received 100 mg Aspirin/day, group 2 received the same dose of Aspirin plus dipyridamole 75 mg twice daily and group 3 received 10 mg warfarin for 3 days followed 5 mg thereafter. All patients were followed every 6 months for relapse of amaurosis fugax and cardiac status. Data were collected and analysed. Forty-nine patients (81.6%) were female and 11 patients (18.4%) were males. The mean ages of patients in group 1, 2, 3 were 44.85±14.56, 45.55±15.49 and 4490±14.87, respectively (P=0.98). The mean duration of amaurosis fugax stroke was 7 minutes (ranged 4-11 minutes). 91.6% of the patients had type A personality by anxiety and neurosis. Stroke was seen in 47 (78.3%) patients in both eyes, in 10 patients (16.6%) in the left eye and in 3 cases (5.1%) in the right eye. After one year of treatment, relapse of amaurosis fugax stroke was developed in 7 (35%) patients in Aspirin group, 5 (25%) in Aspirin plus dipyridamole group and 1 (5%) in warfarin group. Warfarin group had lower relapse than those in other groups (P=0.022). The results show that warfarin has better efficacy for the treatment of amaurosis fugax than Aspirin or Aspirin plus dipyridamole.

To evaluate the effect of intraviteral bevacizumab (IVB) in diabetic macular edema (DME), using multifocal electroretinography (mfERG) Sixty-four eyes of 32 patients with bilateral symmetric clinically significant macular edema (CSME) were included in the study. After taking a baseline mfERG, macular photocoagulation (MPC) was done in all eyes. After 7 days, 1.25 mg of bevacizumab was randomly injected in one eye of each patient and the other eye assigned for sham injection. mfERG was repeated 8 weeks after injection, and changes in visual acuity and mfERG compared in two groups. The mean best corrected visual acuities (BCVAs) at baseline were 0.55 in IVB group and 0.51 in control group and at 8th week were 0.41 and 0.53 respectively, also the amplitude and implicit time showed significant improvement in mfERG. Significant improvement in visual acuity and amplitude of waves of mfERG were observed compared with sham group. IVB injection can augment the effect of MPC in DME and can be used as an adjunctive treatment in these cases.

To determine the incidence, severity and risk factors for retinopathy of prematurity (ROP) in premature infants with late retinal examination at Farabi Hospital from 2001 to 2006.

In a cross-sectional study, hospital records of premature infants who were examined later than 9 weeks after birth were reviewed for possible risk factors of ROP including gender, singleton or multiple gestations, gestational age (GA), birth weight (BW), oxygen therapy, blood transfusion, photo-therapy, and respiratory distress syndrome (RDS), as well as the age at initial examination.

From 693 infants referred for ROP screening, 191 (27.6%) had late retinal examination at mean age of 144.8±158.4 (range 64-1460) days. Of these 191 infants, 75 (39.3%) had different stages of ROP, 58 (30.4%) had stage 4 or 5 disease and 27 (14.1%) had stage 5 ROP in both eyes which were untreatable. GA and BW were associated with development of ROP (P<0.001).

The high prevalence of premature infants with late retinal examination and high incidence of severe ROP necessitates prompt intervention to optimize referral and early screening of premature infants.

To evaluate the success rate of Nd:YAG laser membranotomy in patients with diabetic premacular hemorrhage. This interventional case series included 24 eyes of 22 patients referred to retina clinic of Farabi Eye Hospital, Tehran, Iran during 2000-2007 with chief complaint of sudden loss of vision and clinical diagnosis of premacular hemorrhage due to proliferative diabetic retinopathy. All patients underwent complete ocular examination and color fundus photography. Nd:YAG laser membranotomy was performed in patients with >3 DD hemorrhage. Main outcome measures were success rate of membranotomy, improvement of visual acuity and the complications. Twenty-four eyes of 22 patients (68.2% female and 31.8% male) with diabetic premacular hemorrhage were enrolled. Mean age of patients was 56±6.5 years. Nd:YAG laser membranotomy was successful in 71% of patients resulting in release of trapped blood into the vitreous cavity which absorbed during 14.3±5.03 (range 8 to 27) days. Range of preoperative visual acuity was from hand motion to count finger at 4 m which improved to a range of 20/100 to 20/25 postoperatively. Patients complained of some visual disorders such as blurred vision and floater over 23-86 days (mean 43 days), postoperatively. Macular photocoagulation was performed in 11 eyes with macular edema before panretinal photocoagulation. Mean follow-up period was 34.7±18.3 (range 10-71) months. Nd:YAG laser membranotomy in diabetic premacular hemorrhage is a simple and inexpensive outpatient procedure which results in rapid visual recovery and is relatively safe. Further controlled clinical trials are recommended.

To determine the association between Norrie disease (ND) gene mutations and advanced stages of retinopathy of prematurity (ROP) in premature neonates who were referred to Farabi Eye Hospital, Tehran, Iran during 2005-2007.

Fifty infants including 28 male and 22 female subjects with ROP stage 3 or worse were enrolled in this case series. All three exons of ND gene underwent polymerase chain reaction (PCR) with three primer pairs and direct sequencing to determine any mutation.

Mean birth weight was 1187.6±227.6 (range 580-2000) gram and mean gestational age was 28.6±2.1 (range 24-34) weeks. Thirty-eight patients had stage 3 ROP with plus disease, four patients had stage 4 ROP and eight patients had stage 5 ROP. A C15078A mutation was found in the second intron of 90% of the cases.

C15078A mutation is in a non-translated region of the ND gene and has no effect on mRNA splicing; therefore the association between this ND gene mutation and advanced stages of ROP in Iranian neonates with ROP is not significant.

To evaluate the anatomic and visual results and complications of vitrectomy in eyes with diffuse refractory diabetic macular edema associated with a taut posterior hyaloid. This prospective interventional case series was conducted on 25 eyes of 22 patients with diffuse refractory clinically significant diabetic macular edema, macular thickness greater than 250 mm on optic coherence tomography (OCT) and thickened posterior hyaloid. Best-corrected visual acuity (BCVA) and macular thickness measured by OCT were evaluated preoperatively and repeated 3 and 6 months postoperatively. Macular perfusion was evaluated by fluorescein angiography, pre- and six months postoperatively. Mean BCVA was 1.14±0.51 LogMAR, preoperatively which improved to 0.89±0.53 LogMAR six months postoperatively (P=0.005). Mean preoperative macular thickness was 506±121.9 µm which decreased to 318±90.5 µm, six months postoperatively (P=0.001). Vitrectomy and removal of the posterior hyaloid membrane appears beneficial in eyes with diffuse diabetic macular edema unresponsive to laser therapy and a taut premacular posterior hyaloid.

To investigate etiological factors of endophthalmitis in Farabi Eye Hospital.

In a retrospective study, the clinical records of 223 patients admitted to the hospital with final diagnosis of endophthalmitis between March 2002 and March 2004 were reviewed. Analyzed factors included: age, sex, clinical presentation, clinical course, microbiological data, treatment modality, visual outcome, and surgical complications.

Two hundred twenty three patients with final diagnosis of endophthalmitis were evaluated. One hundred and fifty patients (67%) were male and 73 (33%) were female. 50.2% of the patients were older than 40 years, 14.3% fall in the range of 17-40 years and 30.5% in the range of 2-16 years, and 4.9% were younger than 2 years of age. 57% of endophthalmitis cases were postoperative, 40.5% were posttraumatic, and 2.5% were endogenous. Overall 15.9% of the cases had positive culture. Wound leakage was noted in 39% and vitreous loss in 22% of postoperative patients. During 3.5–6.5 months (mean 4.5 months) visual acuity was 20/400 or better in 69.5% of posttraumatic cases and in 44.5% of postoperative patients. Finally 92.8% of patients required at least one vitrectomy procedure as a part of their management. Evisceration or enucleation was performed in 8.1% as a primary operation or in the course of their treatment.

The incidence of postoperative endophthalmitis in this study is similar to other studies. Posttraumatic endophthalmitis incidence is less than the mean incidence of other reports. The rate of positive culture was also less than other studies.

To evaluate the effectiveness of intravitreal triamcinolone acetonide on visual acuity and macular thickness using optical coherence tomography in macular edema associated with nonischemic central retinal vein occlusion (CRVO). Design: A prospective interventional case series. Patients & Twenty eyes of 25 patients with nonischemic CRVO and macular edema with visual acuity of less than or equal to 0.4 logarithm of minimum angle of resolution (logMAR) received 4 mg intravitreal triamcinolone acetonide after baseline examination which included measurement of best corrected visual acuity (BCVA) and intraocular pressure, slit lamp examination, fluorescein angiography, and optical coherence tomography (OCT) of macula. The main outcome measures were visual acuity after 1, 3, 6, and 9 months and 1-mm central macular thickness change at 3 months after injection. Mean duration of symptoms before injection was (83.72±57.60 days). Mean visual acuity significantly improved from baseline 1.34±0.71 (20/400) to 0.67±0.42 (20/100), P=0.000, 0.61±0.42 (20/80), P=0.000, and 0.90±0.62 (20/160), P=0.004, at 1, 3, 6 months, respectively, but decreased to 1.43±0.76 (20/600), P=0.188 at 9 months. A 42.85% reduction observed in mean baseline 1-mm central macular thickness 634.36 ± 212.70 µm to (362.56±199.63 µm, P=0.000) at 3 months. Intravitreal triamcinolone acetonide can significantly be effective in reducing macular edema and improving visual acuity in nonischemic CRVO at least in short term but it is necessary to investigate the risks and benefits of this option with a control group.