Diabetic Macular Edema Before and After Intravitreal Triamcinolone Injection

( Alireza Ramezani ),( Homa Tabatabaie ),( Hamid Ahmadieh ) 대한안과학회 2007 Korean Journal of Ophthalmology Vol.21 No.2

Purpose: To compare intravitreal triamcinolone acetonide (IVT) versus natural course in refractory diabetic macular edema. Methods: In a prospective interventional case series, twenty five eyes with refractory DME which had been allocated to the sham group of a previous clinical trial underwent new examination and optical coherence tomography about 9 months after their first enrollment. Twenty eyes that met the inclusion criteria, visual acuity (VA) < 20/50 and central macular thickness (CMT) > 200 μm, were treated by 4 mg IVT. Evaluations were repeated at 2 and 4 months post-injection to imitate the similar examination intervals after sham injection. Corrected visual acuity and macular thickness changes following IVT were compared to the corresponding changes after sham injection (the natural course). Results: Visual acuity changes within and between each period were not statistically significant. Visual acuity decreased 0.08 & 0.09 logMAR by 2 months and 0.06 & 0.04 logMAR by 4 months after sham and IVT injections, respectively. The changes of macular thickness after IVT and sham intervention were not meaningful either. However, the difference between thickness changes by 4 months (52±50 μm increase after sham vs. 262±115 μm reduction after IVT) was significant (P=0.014). Conclusions: Concerning macular thickness, IVT has beneficial effect on refractory diabetic macular edema as opposed to observation. However, considering visual acuity, it does not induce significant difference in comparison to the natural course of the disease. Korean Journal of Ophthalmology 21(2):95-99, 2007

Predictors and Outcomes of Vitrectomy and Silicone Oil Injection in Advanced Diabetic Retinopathy

Alireza Ramezani,Hamid Ahmadieh,Amin Rozegar,Masoud Soheilian,Morteza Entezari,Siamak Moradian,Mohammad H Dehghan,Homayoun Nikkhah,Mehdi Yaseri 대한안과학회 2017 Korean Journal of Ophthalmology Vol.31 No.3

Purpose: To evaluate visual and anatomical results and identify factors that influence vitrectomy and silicone oil(SO) injection outcomes in proliferative diabetic retinopathy (PDR). Methods: This retrospective study included 236 eyes with PDR that were undergoing vitrectomy and SO injectionwith >3-month follow-up. The primary outcomes were final best-corrected visual acuity (BCVA) and retinalattachment rate. Results: At the final visit (mean, 88 ± 58 weeks), complete, partial, and no retinal attachment were observed in86.9%, 10.6%, and 2.5% of patients, respectively. A total of 155 eyes had experienced SO removal, while 81had SO in place. The mean initial BCVA was 1.9 ± 0.7 logarithm of the minimum angle of resolution (logMAR)and significantly improved to 1.7 ± 0.8 logMAR (p = 0.001). Initial macular detachment (adjusted odds ratio[AOR], 0.25), development of iatrogenic break (AOR, 0.25), and use of heavy SO (AOR, 0.13) were independentlyassociated with a lower risk of final retinal attachment, and SO removal was associated with a higherincidence (AOR, 7.55). Better baseline BCVA was associated with a higher risk of final BCVA ≥20 / 200. Conclusions: Despite an encouraging outcome based on anatomical data in advanced PDR treated with vitrectomyand SO, the functional prognosis was not satisfying for patients. Eyes with better vision at baseline hada more favorable prognosis, whereas eyes with initial macular detachment, intraoperative iatrogenic break, orheavy SO showed more unfavorable outcomes. In selected cases, extending the time of SO use did not worsenthe prognosis.

Analgesic Effect of Topical Sodium Diclofenac before Retinal Photocoagulation for Diabetic Retinopathy: A Randomized Doublemasked Placebo-controlled Intraindividual Crossover Clinical Trial

Alireza Ramezani,Morteza Entezari,Mohammad Mehdi Shahbazi,Yosef Semnani,Homayoun Nikkhah,Mehdi Yaseri 대한안과학회 2017 Korean Journal of Ophthalmology Vol.31 No.2

Purpose: To evaluate the analgesic effect of topical sodium diclofenac 0.1% before retinal laser photocoagulationfor diabetic retinopathy. Methods: Diabetic patients who were candidates for peripheral laser photocoagulation were included in a randomized,placebo-controlled, intraindividual, two-period, and crossover clinical trial. At the first session andbased on randomization, one eye received topical sodium diclofenac 0.1% and the other eye received an artificialtear drop (as placebo) three times before laser treatment. At the second session, eyes were given thealternate drug. Patients scored their pain using visual analogue scale (max, 10 cm) at both sessions. Patientsand the surgeon were blinded to the drops given. Difference of pain level was the main outcome measure. Results: A total of 200 eyes of 100 patients were enrolled. Both treatments were matched regarding the appliedlaser. Pain sensation based on visual analogue scale was 5.6 ± 3.0 in the treated group and 5.5 ± 3.0 in thecontrol group. The calculated treatment effect was 0.15 (95% confidence interval, –0.27 to 0.58; p = 0.486). The estimated period effect was 0.24 (p = 0.530) and the carryover effect was not significant (p = 0.283). Conclusions: Pretreatment with topical sodium diclofenac 0.1% does not have any analgesic effect during peripheralretinal laser photocoagulation in diabetic patients.

Intravitreal Triamcinolone Reinjection for Refractory Diabetic Macular Edema

( Alireza Ramezani ),( Hamid Ahmadieh ),( Homa Tabatabaei ) 대한안과학회 2006 Korean Journal of Ophthalmology Vol.20 No.3

Purpose: To evaluate the effect of intravitreal triamcinolone acetonide (IVT) reinjection on clinical and optical coherence tomographic features in refractory diabetic macular edema. Methods: In a prospective interventional case series, all IVT treated patients enrolled in a previous clinical trial were recalled to have a new ophthalmologic examination and optical coherence tomography (OCT) performed. Eyes found suitable for reinjection received 4 mg IVT. Complete clinical examination and OCT were repeated at 2 and 4 months post-injection. The changes were statistically analyzed using a paired t test and were compared to the results of the first injections. Results: Of all returning patients, 12 cases with complete records were considered candidates for reinjection. Visual acuity (VA) changes were not significant after the first and second interventions, although there was a relative improvement (0.14 logMAR) 2 months after the first injection. Reductions of central macular thickness (CMT) were 43±69 μm, and 40±69 μm after the first injection and 27±48 μm, 49±58 μm after the reinjection at 2 & 4 months, respectively. None of the mentioned changes was significant. After the second injection, however, intraocular pressure was elevated at both 2 & 4 months (3.6 & 2.4 mmHg respectively, P<0.05). Two months after the first administration, intraocular pressure was found to be raised significantly (5.58 mmHg, P=0.001). Conclusions: The transient beneficial effects of IVT on diabetic macular edema are not repeated with second injections. However, IVT-related ocular hypertension is more persistent after reinjection. Purpose: To evaluate the effect of intravitreal triamcinolone acetonide (IVT) reinjection on clinical and optical coherence tomographic features in refractory diabetic macular edema. Methods: In a prospective interventional case series, all IVT treated patients enrolled in a previous clinical trial were recalled to have a new ophthalmologic examination and optical coherence tomography (OCT) performed. Eyes found suitable for reinjection received 4 mg IVT. Complete clinical examination and OCT were repeated at 2 and 4 months post-injection. The changes were statistically analyzed using a paired t test and were compared to the results of the first injections. Results: Of all returning patients, 12 cases with complete records were considered candidates for reinjection. Visual acuity (VA) changes were not significant after the first and second interventions, although there was a relative improvement (0.14 logMAR) 2 months after the first injection. Reductions of central macular thickness (CMT) were 43±69 μm, and 40±69 μm after the first injection and 27±48 μm, 49±58 μm after the reinjection at 2 & 4 months, respectively. None of the mentioned changes was significant. After the second injection, however, intraocular pressure was elevated at both 2 & 4 months (3.6 & 2.4 mmHg respectively, P<0.05). Two months after the first administration, intraocular pressure was found to be raised significantly (5.58 mmHg, P=0.001). Conclusions: The transient beneficial effects of IVT on diabetic macular edema are not repeated with second injections. However, IVT-related ocular hypertension is more persistent after reinjection.

Original Articles : Causes of Visual Impairment among Patients Referred to a Visual Rehabilitation Clinic in Iran

( Alireza Ramezani ),( Maasome Pardis ),( Nasrin Rafati ),( Mohsen Kazemi Moghaddam ),( Marzieh Katibeh ),( Pooya Rostami ),( Mohammad Hossein Dehghan ),( Mohammad Ali Javadi ),( Zahra Rabbanikhah ) 대한안과학회 2012 Korean Journal of Ophthalmology Vol.26 No.2

Purpose: Epidemiologic evaluation and investigating the causes of visual impairment in any society is a matter of concern and has a direct effect on the country`s health care planning. In this study we describe causes of low vision and blindness in Iranian patients referred to rehabilitation clinics for taking vision aids. Methods: In this cross-sectional study, visual acuity was classified based on best-corrected visual acuity in the better eye according to the World Health Organization definition (blindness, visual acuity [VA]<20/400; severe visual impairment, VA<20/200-20/400; mild to moderate visual impairment, VA<20/60-20/200). The causes of blindness and low vision were determined using the 10th version of International Classification of Diseases based on the main cause in both eyes. To describe data, we used mean±SD and frequency. Results: The study included 432 patients, 65% male, with a mean age of 43.6±25.5 years (range, 3 to 92 years). Mild to moderate visual impairment, severe visual impairment and blindness were present in 122 (28.8%), 196 (46.4%) and 105 (24.8%) of the patients, respectively. The main causes of visual impairment were retinal and choroidal diseases (74.5%), optic nerve and optic tract diseases (9.8%), vitreous and globe disorders (5.3%), congenital cataract (3.1%), and glaucoma (2.6%). The distribution pattern of the causes was similar in all age subgroups. Conclusions: Diseases of the retina and choroid are the main cause of visual impairment among patients referred to an academic visual rehabilitation clinic in Iran.

Case Reports : Intravitreal Bevacizumab for Treatment of Refractory Central Serous Choroidoretinopathy

( Morteza Entezari ),( Alireza Ramezani ),( Mehdi Yaseri ) 대한안과학회 2012 Korean Journal of Ophthalmology Vol.26 No.2

In a clinical case series, 5 patients with not-resolved central serous choroidoretinopathy (CSC) lasting more than 1 year received one intravitreal bevacizumab injection (IVB, 1.25 mg) injection. All patients underwent a through ophthalmic examination 1 day, 1 week, and 1, 2, and 6 months after the injection. Best corrected visual acuity (BCVA) and central macular thickness were compared before and after treatment by optical coherence tomography. Mean BCVA was improved significantly (p=0.020) from 0.60±0.25 to 0.50±0.18 and 0.29±0.19 logarithm of minimum angle of resolution at 6 and 18 weeks, respectively. Central macular thickness was also decreased significantly (p=0.010) from 370±65 to 208±23 μm at 4 months. No recurrence was occurred during follow-up. IVB injection may have beneficial effect in the treatment of refractory CSC.

Simple Preparation of Cuprous Oxide Nanoparticles for Catalysis of Azide-alkyne Cycloaddition

Amini, Mojtaba,Ramezani, Sakine,Anbari, Alireza Pourvahabi,Beheshti, Abolghasem,Gautam, Sanjeev,Chae, Keun Hwa SAGE Publications 2018 Journal of chemical research Vol.42 No.3

The Effect of Flaxseed Enriched Yogurt on the Glycemic Status and Cardiovascular Risk Factors in Patients with Type 2 Diabetes Mellitus: Randomized, Open-labeled, Controlled Study

( Nazila Hasaniani ),( Mehran Rahimlou ),( Amirhossein Ramezani Ahmadi ),( Alireza Mehdizadeh Khalifani ),( Mohammad Alizadeh ) 한국임상영양학회 2019 Clinical Nutrition Research Vol.8 No.4

Flaxseed is one of the rich sources of α-linolenic acid and lignan. Flaxseed and its components have antioxidant, hypolipidemic and hypoglycemic effects. The study aimed to investigate the effect of flaxseed enriched yogurt on glycemic control, lipid profiles and blood pressure in patients with type 2 diabetes. A randomized, open-labeled, controlled clinical trial was conducted on 57 patients with type 2 diabetes. Participants were assigned to receive 200 g 2.5% fat yogurt containing 30-g flaxseed or plain yogurt daily for 8 weeks. Anthropometrics and biochemical parameters were evaluated at the beginning and end of the study. After 8 weeks of supplementation, Hemoglobin A1c was significantly decreased in the intervention group compared to control (p = 0.007). Also, at the end of the study, significant differences were seen between the flaxseed enriched yogurt and control groups in triglycerides and total cholesterol concentrations (p = 0.04 and p = 0.01), systolic blood pressure and diastolic blood pressure (p = 0.02 and p = 0.002, respectively). However, we did not find any difference between 2 groups in low-density lipoprotein, high-density lipoprotein, body weight and waist circumference (p > 0.05). Our results showed that the addition of flaxseed to yogurt can be effective in the management of type 2 diabetes. Trial Registration: ClinicalTrials.gov Identifier: NCT02436369