Purpose: To evaluate the visual outcomes and surgical results of pars plana Vitrectomy for Diabetic macular edema unresponsive to laser therapy using optical coherence tomography (OCT).Materials & Methods: Standard pars plana Vitrectomy with separation of posterior hyaloid was performed in 19 eyes of 17 patients with Diabetic macular edema unresponsive to laser therapy (after 4 months). The macular thickness was evaluated before and after surgery with OCT. Slit lamp examination and visual acuity measurement were performed periodically.Results: After follow up of 3 months, visual acuity improved in 13 cases, decreased in 2 cases and was unchanged in four patients. The postoperative foveal thickness (374.7±114.9) was thinner than the preoperative foveal thickness (512.5±162) that was statistically significant (p=0.002). Postoperative complications included cataract formation (4 cases) and vitreous hemorrhage in one case. Conclusion: In eyes with persistent macular edema unresponsive to laser therapy, Vitrectomy appears to be beneficial in decreasing macular thickness and improving visual acuity.

Purpose: To determine the causes of non-traumatic non-Diabetic vitreous hemorrhage (NDVH) and to report the visual and anatomical outcomes and complications of Vitrectomy for this condition.Method: In a retrospective case series, records of patients who had undergone Vitrectomy for non-traumatic NDVH over a ten year period at Labbafinejad Medical Center, Tehran-Iran with at least six months of follow up were reviewed for causes of the condition and outcomes of surgery.Results: From 1993 to 2003, 50 eyes of 49 patients (51% male) with mean age of 62.7±10.3 (range 35-87) years underwent Vitrectomy for non-traumatic NDVH. Preoperatively, mean best-corrected visual acuity (BCVA) was 2.36±0.52 LogMAR and relative afferent pupillary defect was positive in 91.1% of the eyes. Mean BCVA increased significantly to 1.38±0.72 LogMAR at six months (P<0.0001). Causes of non-traumatic NDVH included: branch retinal vein occlusion (56%), central retinal vein occlusion (16%), choroidal neovascularization (12%) and posterior vitreous detachment with retinal break, Eales’ disease, familial exudative vitreoretinopathy and Terson’s syndrome (each in 4%). The most common causes of poor visual outcomes were: macular pigmentary derangement (26%), optic atrophy (16%), severe lens opacity (12%) and epiretinal membrane (8%). Conclusion: Despite the significant increase in VA following Vitrectomy, irreversible macular or optic nerve pathology limits significant improvement in central visual acuity in several cases of non-traumatic NDVH. Vascular accidents were the most common cause of this condition.

Dear Editor, I have read with great interest the article by Moradian et al on "Topical Umbilical Cord Serum for Corneal Epithelial Defects after Diabetic Vitrectomy. They have performed the study to investigate whether topical umbilical cord serum (TUCS) has any beneficial role in healing corneal epithelial defects (CED) after Diabetic Vitrectomy. However, I have a few concerns about the study. . .

Purpose: To evaluate the role of topical umbilical cord serum (TUCS) therapy in treating corneal epithelial defects (CEDs) after Diabetic Vitrectomy. Methods: In this double-masked, randomized clinical trial, we included 80 eyes of 80 patients who were candidates for Vitrectomy due to proliferative Diabetic retinopathy complications. In cases of corneal edema obscuring the fundus view during surgery, the corneal epithelium was removed using a 6-mm trephine and a blade no. 15. The day after the surgery, patients were randomly divided into two groups: (1) the TUCS group that received 20% TUCS six times/day in addition to the conventional treatment of CED and (2) the control group, which was prescribed artificial tears as placebo in addition to the conventional treatment of CED. The rate of healing of CEDs was measured via two maximum linear dimensions perpendicular to each other at the start of therapy and on postoperative days 1– 5, 7, and 12. Results: Of 80 eyes, 40 were assigned to each treatment group. The mean times to complete CED healing were 2. 4 ± 0. 7 and 3. 8 ± 2. 1 days in the TUCS and control groups, respectively (P < 0. 001). Persistent CED occurred in two eyes in the control group but in no eyes in the TUCS group. Conclusion: TUCS therapy may be safe and effective in healing CEDs after Vitrectomy in patients with diabetes.

Purpose: To determine the visual and anatomical outcomes and complications of Vitrectomy for non-traumatic non-Diabetic vitreous hemorrhage (NDVH) and to report the causes of the condition among patients at Labbafinejad Medical Center, Tehran-Iran, from 1993 to 2003.Method: Records of patients who underwent Vitrectomy for non-traumatic NDVH with 6 months follow-up were reviewed for demographic characteristics, causes of NDVH and results of surgery. Results: Fifty eyes (54.2%right eyes) of 49 patients (51% male) with mean age of 62.7±10.3 years Were enrolled in the study. Mean visual acuity (VA) was 2.36±0.52 LogMAR and relative afferent Papillary defect (RAPD) was positive in 91.7% of the eyes, preoperatively. Causes of non-traumatic NDVH detected intraoperatively were: branch retinal vein occlusion (56%), central retinal vein occlusion (16%), choroidal neovascularization (12%), and posterior vitreous detachment with break, Eales disease, familial exudative vitreoretinopathy, and Terson syndrome (eachin 4%). Mean VA increased significantly at 6th month (1.38±0.72 logMAR) compared to preoperative value. (P<0.0001) The most common causes of decreased VA were: macular pigmentary derangement (26%), optic atrophy (16%), severe lens opacity (12%), and epiretinal membrane (8%). Conclusion: Despite the statistically significant increase in mean VA following Vitrectomy, underlying macular pathology limits significant improvement of central VA in most cases of non-traumatic NDVH.

At the happy ending of vitreoretinal surgery for proliferative Diabetic retinopathy, when all proliferative fibrovascular tissues have been suc ces s ful ly removed, panret inal photocoagulation is completed and there is no iatrogenic break, the surgeon may wonder whether to consider any other intervention before closing the case….

Background and Obiectives: The aim of this study was to evaluate the results and complications of early Vitrectomy in eyes with severe proliferative Diabetic retinopathy and useful vision.Patients & Methods: In a retrospective study, we reviwed the hospital records of 31 patients who had undergone early Vitrectomy for active and sever proliferative Diabetic retinopathy at Labbafi-Nejad Eye Center from 1991 to 1999, and the collected data were analysed statistically.Results: There were 21 male (67.7%) and 10 female (32.3%) patients. The mean age of the patients was 50 yrs (range: 21-71 yrs.) and the mean age at the time of operation was 45.5 yrs (range: 21-66 yrs.). The mean duration of the diabetes and ocular involvement were 15.5 (range: 3-31 yrs.) and 2.37 (range: 0.17-10 yrs.) years respectively. The operation had performed on the right eyes in 16 cases (51.6%) and the left eyes in 15 cases (48.4%). 6 patients had had Type I, 17 patients Type 11and 8 patients Mixed Type of diabetes mellitus. In 26 patients (84%), the fellow eye also had had proliferative Diabetic retinopathy. Preoperative VA was 10/200or better in all of the patients and BCVA was in the range of 10/200 to 20/200in 48.3% and 20/30or better in 13% of patients. At 1 year after the operation, VA increased in 16 patients (51.6%) and decreased in 12 patients (38.7%). VA was less than 10/200in 3 patients and 20/30or better in 7 patients. The most common causes of visual loss at 1 year after operation were macular changes (38.7%) and opacity of lens (19.4%). The most frequent intraoperative complications were retinal breaks in 9 patients (29%) and vitreous hemorrhage in 5 patients (16%).Conclusion: Early Vitrectomy in eyes with severe proliferative Diabetic retinopathy and useful vision can increase the chance of restoring or maintaining good vision specially in patients with type I diabetes mellitus.

Purpose: To evaluate the effectiveness of pars plana Vitrectomy and posterior hyaloid stripping in decreasing macular thickness and improving vision in Diabetic macular edema.Methods: This prospective interventional case series includes 30 eyes of25 Diabetic patients with Diabetic macular edema with macular thickness exceeding 170 microns and thickened posterior hyaloid. BCVA and macular thickness measured by OCT were evaluated preoperatively and 4-6 months postoperatively. Macular perfusion was evaluated by means of fluorescein angiography preoperatively. Treatment consisted of pars plana Vitrectomyand stripping of posterior hyaloid. Results: Mean preoperative macular thickness was 531.97±126.52 µm which decreased to 365.2±103.2, postoperatively (p<0.001). Mean preoperative BCVA (Log MAR) was 0.82±0.39 which improved to 0.65±0.34 postoperatively (P=0.006). According to Pearson correlation coefficient, macular perfusion and presurgical BCVA≤20/200 had statistically significant correlation with post surgical BCVA.Conclusion: Pars plana Vitrectomy and posterior hyaloid stripping lead to decrease in macular thickness and improvement of vision in patients with Diabetic macular edema. All patients are legible to be exposed to the risks of surgery and it is rvandatory to select patients for this modality according to be exposed to the and after documenting the role of vitreousin the pathogenesis of the edema with OCT.