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Diabetic retinopathy is a medical condition of the damaged retina that is caused by diabetes and lack of proper monitoring and treatment, which usually leads to blindness. However, diabetic retinopathy monitoring requires an expert ophthalmologist. Recently, automatic monitoring models with acceptable efficiency are suggested as an alternative for expert ophthalmologists. In this paper, a new diabetic retinopathy monitoring model is proposed by using the Contrast Limited Adaptive Histogram Equalization method to improve the image quality and equalize intensities uniformly as the pre-processing step. Then, EfficientNet-B5 architecture is used for the classification step. The efficiency of this network is in uniformly scaling all dimensions of the network. The final model is trained once on a mixture of two datasets, Messidor-2 and IDRiD, and evaluated on the Messidor dataset. The area under the curve (AUC) is enhanced from 0.936, which is the highest value in all recent works, to 0.945. Also, once again, to further evaluate the performance of the model, it is trained on a mixture of two datasets, Messidor-2 and Messidor, and evaluated on the IDRiD dataset. In this case, the AUC is enhanced from 0.796, which is the highest value in all recent works, to 0.932. In comparison to other studies, our proposed model improves the AUC.

Background Age-related Macular Degeneration (AMD) is a complex eye disease, which is genetically associated with different susceptibility loci. We planned to investigate the possible association of Complement Factor B (CFB) rs4151667 (L9H) variants and their possible interaction with Complement Factor H (CFH) Y402H and Complement factor 3 (C3) rs2230199 (R102G) in AMD. Methods This case-control association study included 216 advanced type AMD patients and 191 healthy individuals for evaluation. Extracted-DNA samples were genotyped for the polymorphic regions of CFB rs4151667 (L9H), CFH Y402H and C3 rs2230199 (R102G). Results The distribution of CFB rs4151667 (L9H) genotypes was not significantly different in the AMD patients compared to that of controls (P = 0.18). The AT genotype frequencies for CFB was non significantly lower in AMD group (6.5% vs. 13.1%, AOR = 0.49, CI = 0.23–1.04, P = 0.064(. The A allele of CFB rs4151667 (L9H) was found to be non-significantly lower in AMD patients. CFB rs4151667 (L9H) had no protective interactional effect against CFH (Y402H) and C3 (R102G) risk variants. Conclusions This study showed that the protective role of CFB rs4151667 (L9H) in AMD is not significant and it has no significant protective interactional effect against CFH (Y402H) and C3 (R102G) risk variants.

Age-related macular degeneration (AMD) is a complex disease, and recent studies have shown role of complement system genes in its development. Complement factor I regulates the complement pathways, and relationship between CFI polymorphisms and AMD is controversial. We evaluated the possible association of complement factor I rs141853578 (G119R) variation with advanced AMD in Iranian patients. We included 371 case–control samples consisting of 220 advanced AMD patients and 151 genetically unrelated healthy controls. Extracted DNA samples amplified to obtain fragment including the polymorphic complement factor I rs141853578 (G119R) region. The distribution of the genotypes was significantly different in the AMD patients compared to that of controls (p = 0.035). The TT genotype frequencies for CFI were significantly higher in AMD group (7.7 vs. 2%, OR 4.67, CI 1.33–16.45, p = 0.016). This significant difference was maintained after adjustment for the effects of age and gender (OR 5.09, CI 1.42–18.20, p = 0.012). The minor allele frequency (T allele) was also significantly higher in AMD patients compared to that of controls (29.3 vs. 21.5% OR 1.51, CI 1.07–2.13, p = 0.018). Current study showed that CFI rs141853578 (G119R) is a risk factor for developing advanced type AMD. This study also suggests that the frequency of G119R polymorphism in our population is not as rare as reported from other populations.

Age-related macular degeneration (AMD) is a complex disease and recently the role of DNA repairing genes in its susceptibility has been studied. It has been hypothesized that polymorphism in DNA repair system genes reduce the capacity to repair DNA damages which may lead to a greater susceptibility to AMD. C-reactive protein (CRP) production is shown to enhance inflammatory processes by increasing oxidative stress and inducing DNA damage. We planned to evaluate the possible association of SMUG1 variants and their possible interaction with high sensitivity CRP levels in AMD.We included 500 case-control samples consisting of 279 advanced type AMD patients and 221 genetically unrelated healthy controls enrolled for evaluation. Extracted-DNA samples were amplified to obtain fragments including the polymorphic region SMUG1 rs3087404. We calculated relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) to clarify possible interaction of different genotypes and CRP levels for AMD.The distribution of the genotypes were not significantly different in the AMD patients compared to that of controls (p = 0.849). The allele frequency for SMUG1 was not different between study groups. No difference of SMUG1 polymorphism between case and control groups was evident in higher CRP levels (CRP3mg/dl) compared with lower CRP levels. SMUG1/CRP synergy indices calculated as RERI = -0.12 and AP = -0.18 while S was not calculable.Our study showed that c.-31A/G-SMUG1 genotypes/alleles do not have any association with the occurrence or severity of advanced type AMD. There was no interaction of CRP levels and SMUG1 genotypes in AMD susceptibility.

To determine the joint effect of complement component 3(C3 R102G) with CC-cytokine ligand2 (CCL2-2518) or complement factor H (CFH) Y402H polymorphisms on advanced age-related macular degeneration (AMD).In this case-control study, 233 patients with advanced AMD and 159 unrelated healthy controls enrolled for evaluation. Selected polymorphisms were determined by polymerase chain reaction and restriction fragment length polymorphism.A combination of AA CCL2 (rs1024611) and GG C3 (R102G) genotypes resulted in a super-additivity of the risks: OR = 10.13, 95% CI 1.04-98.49, p = 0.04, adjusted OR = 7.74, 95% CI 0.71-84.75, p0.1, adjusted synergy indices: relative excess risk due to interaction (RERI) = 1.38, the attributable proportion due to interaction (AP) = 24.7% and the synergy index (S) = 1.43. Combination of at-risk genotypes of CFH Y402H and C3 R102G resulted in a strong super-additive risk: adjusted OR = 22.65, 95% CI 2.32-220.91, p = 0.007, adjusted AP = 90.4% and the S = 12.86. Attributable proportion of risk owing to C3-CCL2 and C3-CFH interaction calculated at 25% and 90% for advanced AMD.We have previously shown a strong association of C3 (R102G) and CFH Y402H with AMD whereas no association was found for CCL2-2518. This study enclosed strong synergistic association of risk genotypes of C3 and CFH Y402H with AMD. We also revealed synergistic influence of CCL2-2518 and the at-risk genotype of the C3 in AMD with an estimated AP = 50.9% (adjusted AP = 24.7%). Present findings show that CCL2-2518 polymorphism is not an innocent bystander in AMD susceptibility when combined with the at-risk genotype of C3 (R102G).

Introduction: Diabetic retinopathy (DR) is the most frequent microvascular complication of diabetes and can lead to several retinal abnormalities including microaneurysms, exudates, dot and blot hemorrhages, and cotton wool spots. Automated early detection of these abnormalities could limit the severity of the disease and assist ophthalmologists in investigating and treating the disease more efficiently. Segmentation of retinal image features provides the basis for automated assessment. In this study, exudates lesion on retinopathy retinal images was segmented by different image processing techniques. The objective of this study is detection of the exudates regions on retinal images of retinopathy patients by different image processing techniques. Methods: A total of 30 color images from retinopathy patients were selected for this study. The images were taken by Topcon TRC-50 IX mydriatic camera and saves with TIFF format with a resolution of 500 × 752 pixels. The morphological function was applied on intensity components of hue saturation intensity (HSI) space. To detect the exudates regions, thresholding was performed on all images and the exudates region was segmented. To optimize the detection efficiency, the binary morphological functions were applied. Finally, the exudates regions were quantified and evaluated for further statistical purposes. Results: The average of sensitivity of 76%, specificity of 98%, and accuracy of 97% was obtained. Conclusion: The results showed that our approach can identify the exudate regions in retinopathy images.

Introduction: Age-related macular degeneration (AMD) has become a catastrophic health problem throughout the world because of the aging population. Destruction of the macular architecture in the wet type form is a major problem that results from AMD and is irreversible. Working on preventive measures is, therefore, of critical importance. Because pentraxins (PTX) become elevated in the body in stressful, oxidized conditions, this study examines the role they play in AMD. The similarity between the pathophysiology of atherosclerosis and AMD and the role of PTX3 in atheromas were also factors that support conducting this study. Methods: This case-control study used 40 eyes that were at different stages of wet type AMD. The eyes were from patients who were over the age of 50 and had not had intraocular surgery or choroidal neovascularization (CNV) due to non-AMD causes. The control group included 49 eyes with normal macula. These study groups were matched according to age and gender, and the serum levels of PTX3 were analyzed. Results: The mean ages of the patients were 70.7 ± 9.0 and 69.6 ± 7.4 years among the case group and the control group, respectively (P = 0.540) while the male to female ratios were 2.64 and 1.19, respectively (P = 0.091). The PTX3 (P = 0.002), high-sensitivity C-reactive protein (hs-CRP) (P = 0.008) and triglyceride (TGs) (P = 0.032) were significantly higher among the wet type AMD cases. Conclusion: PTX3 appears to be a component in the pathogenesis of AMD and, therefore, could be a target for possible pharmaceutical interventions to stop or reduce the progression of this ominous disease.

Background: Cost and cost analysis is a managerial tool that can place needed data at managers’ disposal and help them in making informed decisions in investing services and infrastructures. Objectives: The aim of this study was to estimate the cost of eye surgeries and compare them with tariffs approved by the Iranian ministry of health. Methods: The present retrospective-descriptive study was carried out at Nikookari ophthalmic hospital, from April 2013 to April 2014, in Tabriz, Iran. Surgical operations of cataract, strabismus and glaucoma were considered on the grounds that they were global and the most frequent. The required data was collected through conducting interviews with experts and relevant units, direct observation of activities, analysis of documents in the financial department, and hospital information system (HIS) and financial software system of the hospital. The cost of surgical operations was estimated by activity based costing (ABC). Results: According to the findings, the amount and the share of the total costs of the activities identified in the main centers were as following: human resources $2 818 722, depreciation of medical equipment $277 233, consumable medicals and supplies $218,484, building depreciation $138004, depreciation of non-medical equipment $43640, consumable non-medicals and supplies $26804, utility costs $4724, and costs of indirect units $864 455. Ultimately, the costs of different surgeries were estimated to be as follows: strabismus surgery $464, glaucoma $505 and cataract surgery $400, which respectively had $235, $298 and $75 difference with the approved governmental tariffs. Conclusions: This price gap can negatively affect the performance and quality of services provided by hospitals in the long term. Since the costs of personnel, indirect costs and depreciation of medical equipment account for 90% of the total costs of surgery, hospital managers should pay more attention to these issues in order to improve efficiency and reduce costs.

Diabetic retinopathy accounts for a considerable amount of the blindness especially among the patients who are between 20 to 60 years. The early detection of this disease plays an important role in preventing vision damages and appropriate follow-up care of diabetic eye. Manual investigation of color fundus images to check morphological changes in dark and bright lesions is tedious work and very time-consuming that can be made easily with the help of computer-aided diagnosis system. Many techniques were proposed for early detection of the abnormalities in the retinal images help the ophthalmologists recognize the retinopathy earlier. This paper presents a review of various automated algorithms that have been used for the detection of diabetic retinopathy.

Age related macular degeneration (AMD) is the leading cause of irreversible blindness in the elderly population. Inflammatory mediators play an important role in AMD pathogenesis and immune-related gene polymorphisms are shown to increase the risk. Complement system is an important mediator of the immunity system and several genes encoding proteins involved in this system are associated with susceptibility to AMD. The central element of the complement cascade, C3 has been a plausible candidate since its cleavage product C3a was found in drusen. This study was planned to evaluate the association of C3-rs2230199 (R102G) variants with advanced type AMD in this cohort.In this case-control study, 494 participants consisting of 266 AMD patients (187 wet AMD and 79 advanced dry AMD) and 228 samples from unrelated healthy controls were enrolled for evaluation. Extracted-DNA samples were amplified to obtain fragments including the polymorphic region.The distribution of the R102G genotypes was significantly different in the AMD patients compared to controls (p = 0.001).The Odds Ratio compared to CC individuals was 1.69 (95% CI 1.15-2.49) for GC individuals and 6.48 (95% CI1.87-22.43) for GG individuals. The Odds Ratio compared to the C allele was 2.31 (95% CI 0.48-11) for the G allele. GG and GC genotypes and G allele were significantly associated with both types of advanced-AMD. Individuals carrying GG genotype have over a six-fold risk of developing AMD in comparison to those carrying the CC genotype in this cohort. Our meta-analysis pooled data showed that our homozygous individuals for GG have a higher risk of AMD compared to previous publications in different nations (p = 0.017).Our study shows C3 to be a relatively strong susceptibility gene for advanced-type-AMD (exudative-and-geographic-atrophy) in an Iranian population.

PURPOSE Disequilibrium between oxidative stress and antioxidant levels has been proposed as an important case of exudative age-related macular degeneration (AMD). The aim of the present study was to investigate homocysteine (Hcy) level and antioxidant paraoxonase 1 (PON1) activity within its phenotypes together with oxidized low-density lipoprotein (OX-LDL) levels in the patients with exudative AMD. METHODS Serum PON1 activity and plasma Hcy and OX-LDL levels were analyzed in 45 exudative AMD patients and compared with 45 healthy controls. Paraoxonase 1 activity was measured in serum using paraoxon and phenylacetate as substrates. The PON1 phenotype was determined using double-substrate method. Homocysteine and OX-LDL levels were determined by enzyme-linked immunosorbent assay method. RESULTS The distribution of PON1 phenotypes was significantly different between the patients with exudative AMD and control subjects (chi-square = 6.17, P = 0.01). AA phenotype with low activity was significantly more frequent in exudative AMD patients compared with healthy subjects (62.2% vs. 35.6%, respectively). Other phenotype frequencies in the patients compared with controls were as AB phenotype (intermediate activity) 28.9% versus 46.7% and BB phenotype (high activity) 8.9% versus 17.8%, respectively. Except in BB phenotype (P = 0.2), patients with AA and AB phenotypes had higher plasma Hcy levels in comparison to those of controls (P = 0.02 and P = 0.03, respectively). The mean OX-LDL levels, in all 3 phenotypes (P < 0.05), and OX-LDL/high-density lipoprotein ratio, in AA and AB phenotypes (P = 0.001, P = 0.1, respectively) but not in BB (P = 0.1), were significantly higher in the patients than controls. No significant differences in comparison of Hcy and OX-LDL levels between 3 PON1 phenotypes in both control (P = 0.6 for Hcy, P = 0.7 for OX-LDL) and patients (P = 0.8 for Hcy, P = 0.6 for OX-LDL) were found CONCLUSION Increased plasma OX-LDL levels and ratios of OX-LDL/high-density lipoprotein, as biomarkers of lipoprotein oxidative stress, higher levels of Hcy, as oxidant agent, and more common low or intermediate PON1 activity in patients with exudative AMD, compared with controls, indicate that PON1 activity is insufficient to explain the increased oxidative stress observed in exudative AMD.

Background: Age-related macular degeneration (AMD) is the most common cause of elderly irreversible vision loss in the world. Since C-reactive protein (CRP) is a potential risk factor that has been known to induce AMD, this study was designed to explore the relationship between AMD and serum levels of high sensitivity C-reactive protein (hsCRP), and endothelin-1 (ET-1). Methods The subjects were 48 males with AMD (28 with wet type and 20 with dry type) having a mean age of 69.4 ± 9.6 years and a matched group of 45 apparently healthy control subjects. The AMD was diagnosed using a slit-lamp with super filled lens, fundus photography and fluorescein angiography. Levels of hsCRP and ET-1 were determined using ELISA methods. Results: hsCRP (6.96 ± 5.15 vs. 3.64 ± 4.67 mg/l, P

Purpose: To evaluate the effects of onion juice on sodium-selenite induced cataract formation. Materials and Methods: Thirty-two 10-day-old Wistar-albino rat pups were divided into four equal groups. Group 1 received only subcutaneous saline injection. In Group 2, sodium-selenite (30 nmol / g body weight) was injected subcutaneously. In Group 3, subcutaneous sodium-selenite was injected and one drop 50% diluted fresh juice of crude onion was instilled every 8 h into the right eye for 14 days; the left eye received no treatment. Group 4 rats were similar to those of Group 3, the only difference being that of undiluted fresh juice of crude onion. The development of cataract was assessed. Rat lenses were analyzed for total antioxidant (TA) level, and for activities of glutathione peroxidase (GPX) and superoxide dismutase (SOD). Results: Both eyes of all rats in Group 1 did not exhibit cataract formation . In Group 2, all rats developed Grade 3 cataract in the lenses of both eyes. The difference in exhibited cataract in the lens of the right eyes in all rats between Group 2 and any eyes of groups 3 or 4 were significant ( P = 0.001). The mean TA level and mean activities of SOD and GPX in Group 2 rat lenses were significantly lower than the values in lenses of all rats in Group 1 ( P = 0.001, 0.003, 0.001), and in the lenses of the right eyes of rats in Groups 3 and 4 ( P = 0.001, 0.020, 0.001). Conclusion: Instillation of onion juice into the rat eyes can effectively prevent selenite-induced cataract formation. This effect was associated with increased TA level, SOD and GPX activities in the lens.

Purpose To evaluate the association of CC-cytokine ligand 2 CCL2–2518 (rs1024611) single nucleotide polymorphism, complement factor H (CFH Y402H) and their possible interaction in developing advanced age-related macular degeneration (AMD). Methods In this case–control study, DNA samples from 266 patients with advanced AMD and 229 healthy controls were genotyped for CCL2 polymorphism and also 254 patients and 164 healthy controls were genotyped for CFH polymorphism. The possible associations of these polymorphisms with susceptibility to AMD independently and in different joint combinations were evaluated. Results The genotype frequency for CFH was found to be significantly different between AMD and normal controls (31.5% versus 20.7%, OR = 3.56, p

To investigate the effect of preprocessing techniques including contrast enhancement and illumination correction on retinal image quality, a comparative study was carried out. We studied and implemented a few illumination correction and contrast enhancement techniques on color retinal images to find out the best technique for optimum image enhancement. To compare and choose the best illumination correction technique we analyzed the corrected red and green components of color retinal images statistically and visually. The two contrast enhancement techniques were analyzed using a vessel segmentation algorithm by calculating the sensitivity and specificity. The statistical evaluation of the illumination correction techniques were carried out by calculating the coefficients of variation. The dividing method using the median filter to estimate background illumination showed the lowest coefficients of variation in the red component. The quotient and homomorphic filtering methods after the dividing method presented good results based on their low coefficients of variation . The contrast limited adaptive histogram equalization contrast limited adaptive histogram equalization increased the sensitivity of the vessel segmentation algorithm up to 5% in the same amount of accuracy. The contrast limited adaptive histogram equalization technique has a higher sensitivity than the polynomial transformation operator as a contrast enhancement technique for vessel segmentation. Three techniques including the dividing method using the median filter to estimate background, quotient based and homomorphic filtering were found as the effective illumination correction techniques based on a statistical evaluation. Applying the local contrast enhancement technique, such as contrast limited adaptive histogram equalization, for fundus images presented good potentials in enhancing the vasculature segmentation.

Calcification and inflammation are among the important cases of exudative age-related macular degeneration (E-ARMD). The aim of the present study was to elucidate if there is any relationship between serum Osteoprotegerin (OPG), soluble receptor activator of nuclear factor-kappa B ligand (RANK-ligand) and E-ARMD. In a cross-sectional study, we compared 45 E-ARMD patients with 45 matched controls. Diagnosis was confirmed by fluorescein angiography. Serum samples were analyzed for OPG, RANK-ligand, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG). The levels of OPG and RANK-ligand were measured by ELISA methods. The mean age was 72.0±11.5 years in the E-ARMD group and 68.2±8.9 years in the control group (p=0.09). The level of serum OPG was 132.10±75.49 pg/ml in the E-ARMD group and 94.88±61.65 pg/ml in the control subjects. E-ARMD patients had significantly high levels of OPG (p=0.012), as well as significantly high levels of LDL-C and TC (p=0.001 and p=0.005, respectively). We could not find any significant difference in RANK-ligand, HDL-C, or TG between two study groups (p>0.05). To the best of our knowledge, this is the first study investigating the levels of OPG in E-ARMD patients. The present study showed that E-ARMD patients had high levels of serum OPG. It may act as a protective factor for E-ARMD or only as a secondary phenomenon of different processes of E-ARMD. Further prospective studies would be necessary for prognostic and predictive significance of OPG in patients affected by E-ARMD.

Age-related macular degeneration (AMD) is the most common cause of irreversible vision loss and debilitating disease in old age, which involves the central retina/macula among elderly patients. The genetic and environmental factors have important role in this multifactorial disease. Oxidative stress and DNA damages would have important impact on the onset and progression of AMD. In this study, the possible association of c.-31A>G (rs3087404) polymorphism in the promoter region of SMUG1 gene with AMD disease was investigated. Fifty five AMD patients and 130 healthy age-, gender- and ethnicity-matched unrelated people as control group were genotyped by restriction fragment length polymorphism PCR (RFLP-PCR). Both groups were from Northwest of Iran (Tabriz). Statistical analysis showed a significant association of AG genotype of this polymorphism with AMD. These results suggest a possible protective effect of this genotype for AMD disease ( P =0.02, OR=0.574) among patients from Northwest of Iran. This genotype was observed more frequently in controls compared to the patients (59.23% v s 45.45%).

Purpose: To customize clinical practice guidelines (CPGs) for management of diabetic retinopathy (DR) in the Iranian population. Methods: Three DR CPGs (The Royal College of Ophthalmologists 2013, American Academy of Ophthalmology [Preferred Practice Pattern 2012], and Australian Diabetes Society 2008) were selected from the literature using the AGREE tool. Clinical questions were designed and summarized into four tables by the customization team. The components of the clinical questions along with pertinent recommendations extracted from the above-mentioned CPGs; details of the supporting articles and their levels of evidence; clinical recommendations considering clinical benefits, cost and side effects; and revised recommendations based on customization capability (applicability, acceptability, external validity) were recorded in 4 tables, respectively. Customized recommendations were sent to the faculty members of all universities across the country to score the recommendations from 1 to 9. Results: Agreed recommendations were accepted as the final recommendations while the non-agreed ones were approved after revision. Eventually, 29 customized recommendations under three major categories consisting of screening, diagnosis and treatment of DR were developed along with their sources and levels of evidence. Conclusion: This customized CPGs for management of DR can be used to standardize the referral pathway, diagnosis and treatment of patients with diabetic retinopathy.

Nader Baharivand, Amirhossein Hariri, Alireza Javadzadeh, Ebadollah Heidari, Karim SadegiNikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, IranPurpose: To evaluate the effects of vitrectomy and internal limiting membrane peeling for treatment of macular edema secondary to retinal vein occlusion (RVO).Methods: Nine cases of visual loss due to macular edema caused by central retinal vein occlusion or branch retinal vein occlusion underwent pars plana vitrectomy with removal of the preretinal hyaloid, peeling of the internal limiting membrane stained with indocyanine green dye, air–fluid exchange, and postoperative prone positioning. Best-corrected visual acuity (BCVA) and central foveal thickness by optical coherence tomography were measured pre- and postoperatively then compared to assess the outcome of surgery.Results: In all cases intraretinal blood and retinal thickening diminished within 2 months of surgery. Visual acuity improved in all of the central retinal vein occlusion cases and 3/6 branch retinal vein occlusion cases. The decrease in macular thickness was statistically significant (mean postoperative macular thickness 361 ± 61.1 versus mean preoperative macular thickness 563.9 ± 90.0, P = 0.001, t-test). The improvement in BCVA was not statistically significant (mean preoperative BCVA in LogMAR 1.23 ± 0.29 versus mean postoperative BCVA in LogMAR 1.06 ± 0.49, P = 0.09, t-test).Conclusion: In eyes with macular edema secondary to RVO, pars plana vitrectomy with internal limiting membrane peeling can resolve macular edema, but the improvement in BCVA was not statistically significant in this study.Keywords: air–fluid exchange, retinal thickening, retinal hypoxia, concomitant retinal ischemia

Purpose The aim of this study was to evaluate the effect of Helicobacter pylori (H. pylori) treatment on remission of idiopathic central serous chorioretinopathy. Methods Twenty-five patients with idiopathic central serous chorioretinopathy (ICSCR) who were infected with H. pylori were treated with an anti-H. pylori treatment; another twenty-five patients with the same clinical presentations served as the control. Baseline examination and follow up visits at 2, 4, 6, 8, 12, and 16 weeks after the onset of treatment included visual acuity testing and subretinal fluid measurement. The difference between mean visual acuity at the end of 16 weeks and the time of subretinal fluid reabsorption was compared between the two groups. Results Subretinal fluid reabsorption time was 9.28±3.20 weeks in the treatment group and 11.63±3.18 weeks in the control group, which was statistically significant (p=0.015). After 16 weeks, mean visual acuity improved to 0.003±0.01 (logMAR) in the treatment group and 0.004±0.02 (logMAR) in the control group. This improvement did not represent a statistically significant difference (p=0.97). Conclusions An anti-H. pylori treatment regimen is effective in the treatment of idiopathic central serous chorioretinopathy patients and anti-H. pylori treatment can provoke the faster reabsorption of subretinal fluid.

Purpose: The main aim of this study was to evaluate the inhibitory impacts of the aqueous extract of garlic (Ga) on the formation of cataract induced by sodium selenite (Se). Methods: Thirty-two Wistar albino rat pups (4 equal groups: G1, G2, G3, and G4) were treated as follows: G1, subcutaneous (s.c.) and intraperitoneal (i.p.) injection of normal saline (0.3 mL) on postpartum (day 10); G2, i.p. injection of aqueous extract of garlic (1 mL/kg body weight) and s.c. injection of normal saline (0.3 mL) on postpartum (day 10); G3, s.c. injection of sodium selenite (20 nmol/g body weight) and i.p. injection of normal saline (0.3 mL) on postpartum (day 10); and G4, s.c. injection of sodium selenite (20 nmol/g body weight) and i.p. injection of aqueous extract of garlic (1 mL/kg body weight) on postpartum (day 10). Daily i.p. injections of aqueous extract of garlic (in G2 and G4) and normal saline (in G1 and G3) were continued for 14 days. The development of cataract was assessed over a period of 2 weeks after injection of sodium selenite. For further examination, the rats’ lenses were removed and analyzed for glutathione (GSH), malondialdehyde (MDA) levels, and superoxide dismutase (SOD), glutathione peroxidase (GPX) activities. Results: In G3 (Se-treated group), all rats developed grade 3 cataract in both eyes. However, in G1 (untreated control group), G2 (Ga-treated group), and G4 (Ga–Se-treated group), the lenses in both eyes of all rats remained clear ( P < 0.0001). This clinical fi nding was associated with higher GSH level and GPX, SOD activities and lower level of MDA in the Se- and Ga-treated group (G4) compared with SS-treated group (G3) rat lenses ( P < 0.003). Conclusions: Intraperitoneal injection of the Ga in rat model appeared to effectively prevent Se-induced cataract, thus such herbal remedy may be considered for treatment of cataract.

This study aimed to provide the analysis of clinical presentation, results of laboratory and imaging investigations as well as clinical outcome of children with cholestasis. Infants with neonatal cholestasis referred to Children's Hospital from 2002 to 2007 were participated in the study in a cross-sectional prospective study. Appropriate diagnostic criteria and tests were employed for diagnosis the underlying etiologies of neonatal cholestasis. One year mortality rate was determined. One hundred twenty one infants, 75 males and 46 females, with the mean age of 58.3 +/- 15.3 (14-120) days were enrolled in study. Jaundice (94.2%) and hepatomegaly (66.1%) were the most frequent symptom and signs on admission. Idiopathic neonatal hepatitis (36.4%), extrahepatic biliary atresia (24.8%), metabolic disease (20.7%), intrahepatic ductal paucity (10.7%), intrauterine infection (3.3%) were the most frequent causes of neonatal cholestasis. One year mortality was 5.8%. There is still not one effective and specific diagnostic method in differentiating between the causes of cholestasis in the newborns and infants. Some potentially important differences in the disease pattern, initial presentation and long-term outcome are suggested from the present study when compared to previous reports from other parts of the world.

Introduction The surgical correction of anomalous movement such as upshoot in Duane syndrome is challenging. Lateral rectus muscle disinsertion and reattachment to the lateral orbital wall is a new approach used to minimize or eliminate the effects of co-contraction including globe retraction, palpebral fissure narrowing and anomalous vertical movement. Case presentation We report a case of a 7-year-old boy who underwent this procedure for severe upshoot, globe retraction and exotropia in the left eye due to Duane syndrome. The patient achieved satisfactory ocular alignment following surgery. Upshoot and globe retraction were substantially improved. Conclusion Lateral rectus muscle disinsertion and reattachment to the lateral orbital wall is a safe and effective procedure for weakening of the anomalous lateral rectus muscle in Exotropic Duane Syndrome.

To determine the susceptibility of low-density lipoprotein (LDL) to oxidation in the plasma of male patients with wet type age related macular degeneration (AMD) and in a similar control group, in order to evaluate the LDL oxidative status as risk factor of AMD.We conducted this study in the Retina Service, Department of Ophthalmology, Nikookari Eye Hospital-Drug of Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran during the period between October 2004 and December 2005. Sixty male patients with AMD (mean age 67 +/- 16 years) with BMI 4.1 +/- 1.3 were selected as the patient group. The control group consisted of 60 males, apparently healthy, and without ophthalmologic signs and family history of AMD. Low-density lipoprotein was isolated by gradient ultracentrifugation and susceptibility of LDL to in vitro copper-mediated oxidation was assayed by measuring conjugated dienes production (lag phase duration) at 234 nm. Lipid and lipoproteins were determined by standard methods.Comparing with control, significant reduction in the duration of lag phase (p0.004) and a significant increase in LDL-C concentrations (p=0.006), were noticed. No significant change in cholesterol (p0.3), triglyceride (p0.1) and high density lipoprotein cholesterol (p0.1) levels were found between control and patient groups. A significant negative correlation between Lag phase and LDL-C levels (p=0.004, r=-0.364) was found in the patient group.The increased LDL concentration and enhanced susceptibility of LDL to oxidation may play a roll in the wet type AMD process.

Background To investigate the efficacy of posterior subtenon methylprednisolone acetate injection in treatment of refractory diffuse clinically significant diabetic macular edema (CSME). Methods In a prospective, nonrandomized, interventional case series, 52 eyes were diagnosed with CSME and treated with at least two sessions of laser photocoagulation according to Early Treatment Diabetic Retinopathy Study guidelines. At least 3 months after laser therapy, eyes with a residual central macular thickness were offered posterior subtenon injection of 40 mg methylprednisolone acetate. Main outcome measures were visual acuity, macular thickness and intraocular pressure. Potential complications were monitored, including intraocular pressure response, cataract progression and scleral perforation. Results Mean baseline visual acuity (in logMAR) improved significantly (p = 0.003) from 0.8 ± 0.36 to 0.6 ± 0.41 at 3 months. Mean foveal thickness decreased from 388 ± 78 μm at baseline to 231 ± 40 μm after 3 months (p < 0.0001). Visual acuity improvement in eyes with CSME with extrafoveal hard exudates was significant (p = 0.0001), but not significant in eyes with CSME with subfoveal hard exudates (p = 0.32). Intraocular pressure increased from 14.7 ± 2.0 mmHg (range, 12–18 mmHg) to a maximum value of 15.9 ± 2.1 mmHg (range, 12–20 mmHg) during the follow-up period. Complications in two eyes developed focal conjunctival necrosis at the site of injection. Conclusion Posterior subtenon methylprednisolone acetate may improve early visual outcome in diffuse diabetic macular edema that fails to respond to conventional laser photocoagulation. Visual acuity improvement in eyes with CSME with extrafoveal hard exudates was significant; and this improvement is depends on location of hard exudates. Further study is needed to assess the long-term efficacy, safety, and retreatment.

Background Gyrate atrophy of the retina and choroid is a rare autosomal recessive inherited disease, characterized by progressive chorioretinal atrophy that results in progressive deterioration of peripheral and night vision and leading to blindness. Case presentation This report presents a case of a 28-year-old man consulting for a progressive fall of visual acuity with hemeralopia. Eye fundoscopy showed regions of confluent rounded chorioretinal atrophy. The visual field and retinal angiography were altered. A high level of plasma ornithine (629 nmol/mL) was detected and a diagnosis of gyrate atrophy of the retina and choroid was made. The patient was treated with high dose Pyridoxine supplement (300 mg/d for 6 months) and the ornithine level of his serum was successfully reduced. Conclusion The exact mechanism of chorioretinal atrophy in hyper-ornithinemia is not known and a small percentage of the affected people respond to Vitamin B6 supplementation.

Purpose To report an unusual presentation of pellucid marginal degeneration (PMD). case report A 57-year-old man with history of corneal ectasia experienced acute hydrops and spontaneous corneal perforation in his right eye. Examination revealed PMD in both eyes. After initial treatment with cyanoacrylate adhesive and a bandage contact lens, therapeutic penetrating keratoplasty was undertaken in the right eye. Due to severity of the condition, the fellow eye was also scheduled for penetrating keratoplasty. Conclusion Spontaneous corneal hydrops and perforation may occur in patients with corneal ectasia due to PMD.