Purpose:To describe spectral-domain optical coherence tomography (SD-OCT) morphological characteristics in patients with cone dysfunction disorders. Methods:This retrospective, single-center observational study was conducted at a tertiary referral university eye hospital between July 2018 and September 2020. Forty-two patients (84 eyes) with cone dysfunction disorders, diagnosed based on clinical findings and electroretinogram evidence of severely reduced or non-recordable cone responses with preserved rod function, were included in our study. SD-OCT imaging was performed, and images were evaluated regarding the integrity and pattern of hyper-reflective outer retinal bands. The relationship between these findings, age, central retinal thickness (CRT), and best-corrected visual acuity (BCVA) was assessed. Results:SD-OCT images of 82 eyes showed outer retinal abnormalities. Five SD-OCT morphological categories were found, including outer retinal atrophy (24.4%), poorly delineated outer retinal bands (22.0%), ellipsoid zone (EZ) disruption (19.5%), outer foveal defect (17.1%), and prominent outer retinal layers (17.1%). Additionally, five isolated OCT findings were detected, including foveal hypoplasia (14.6%), trans-retinal hyperreflective dots (THD) (29.3%), outer plexiform layer (OPL) schisis (11.0%), subretinal drusenoid-like deposits (9.8%), and EZ bowing (13.4%). Age and CRT were significantly different across the morphological categories (p<0.001). Eyes with prominent outer retinal layers had the best visual acuity, whereas those with outer retinal atrophy had the worst visual acuity; however, differences in BCVA among the morphological categories were not statistically significant in the univariate GEE analysis (p = 0.09) or after multivariable adjustment (p = 0.32). Conclusion:SD-OCT imaging demonstrates diverse outer retinal morphological patterns in patients with cone dysfunction disorders. These patterns were associated with age and CRT but were not significantly associated with BCVA. The proposed morphological classification may help characterize disease morphology and warrants prospective evaluation in longitudinal, genetically characterized cohorts to determine its potential utility as a biomarker.

Purpose:This study aimed to compare macular vascular changes one and three months after treatment with either panretinal photocoagulation (PRP) or intravitreal bevacizumab (IVB). Methods:A total of 62 eyes with very severe non-proliferative diabetic retinopathy or early proliferative diabetic retinopathy without center-involved diabetic macular edema, were included in this retrospective study. Thirty-nine eyes were allocated to the PRP group, while 23 eyes were treated with IVB. Optical coherence tomography angiography (OCTA) was performed to measure foveal avascular zone (FAZ) characteristics as well as the densities of superficial and deep capillary plexuses (SCP and DCP). Results:In the IVB group, the FAZ area and perimeter expanded at month one but returned to baseline level after three months. In the PRP group, however, the FAZ area and perimeter were rather steady. Changes in the FAZ area were significantly different between the treatment groups at month one (P = 0.02), but not at month three (P = 0.31). There was no significant difference in the change in FAZ circularity index between the two groups at each time point (P = 0.55 and P = 0.31). Similarly, changes in SCP density were not statistically significant between the two groups at both time points (all Ps > 0.05). A comparison of the two treatment arms based on the mean change in DCP density revealed a significant difference at month one, but not at month three (P = 0.01 and P = 0.49, respectively). Conclusion:Although bevacizumab and PRP have different short-term macular vascular responses, both therapies have the ability to normalize or stabilize vascular measures over time.

Considering the various manifestations of coronavirus disease 2019 and its imperative importance in terms of the right clinical approach and early management, we sought to present a hemicentral retinal vein occlusion case, with a history of heterozygosity of methylenetetrahydrofolate reductase (MTHFR) genes and potential for clotting complications as a late manifestation of coronavirus disease 2019, and provide a brief review of reported retinal vein occlusion cases in patients with coronavirus disease 2019. A 35-year-old Iranian patient presented with a visual impairment in the left eye 4 months after recovering from coronavirus disease 2019. He reported a mild blurring of vision in the same eye a few days after admission due to coronavirus disease 2019. The ophthalmic evaluation was compatible with hemicentral retinal vein occlusion. Systemic and laboratory workups were negative except for borderline protein C activity, homocysteine levels, and heterozygosity of MTHFR genes. The patient was scheduled to receive three monthly intravitreal antivascular endothelial growth factor injections. We present a case of inferior hemicentral retinal vein occlusion case with an MTHFR mutation with sequential loss of vision 4 months after coronavirus disease 2019 to make clinicians aware of the possibility of late ocular coronavirus disease 2019 manifestations.

In this randomized controlled trial, we assessed the effects of three consecutive intra-silicone oil (SO) injections of methotrexate (MTX) on the outcomes of surgery for proliferative vitreoretinopathy grade C (PVR-C). Seventy-four eyes of 74 patients with PVR-C were included. Of these, 37 eyes were assigned to the MTX group and 37 eyes to the control group. Fourteen patients failed to comply with the 6-month follow-up period. All eyes underwent vitrectomy and SO injection. In the MTX group, 250 mu g MTX was injected into the SO after surgery and at weeks 3 and 6 postoperatively. The primary outcome was the retinal reattachment rate at 6 months. The secondary outcomes included limited PVR recurrence and adverse events. Retinal reattachment was achieved in 22 eyes (73.3%) in the MTX group and 23 eyes (76.7%) in the control group (difference: -3.4%, 95% CI: -25.2-18.5%). Limited PVR recurrence was observed in one eye (4.5%) in the MTX group versus nine eyes (39.1%) in the control group at 6 months (P = 0.01). No adverse effects were observed. Adjunctive treatment with three consecutive applications of intra-SO MTX did not reveal a significant effect on the retinal re-detachment rate but could statistically significantly reduce limited PVR recurrence.Trial registration: http//ClinicalTrials.gov NCT04482543, 22/07/2020.

BACKGROUND:Cicatricial lower eyelid retraction is a challenging condition. It involves scarring of the lower eyelid, which causes it to retract and expose the sclera. This can lead to complications such as dry eye syndrome and corneal melting. It can be caused by trauma, burns, or previous eyelid surgery. Detailed assessment and understanding of eyelid anatomy and retraction are critical for successful surgical planning. Dynamic and static examinations of the eyelid including measurements of the lower eyelid margin reflex distance (MRD2) and scleral show are also essential to determine the appropriate treatment approach. METHODS:A systematic review was conducted using Medline, Scopus, and Cochrane databases with keywords related to cicatricial lower eyelid retraction. The publication language was limited to English after 2000. A total of 29 articles were included for data extraction and analysis. RESULTS:The main surgical techniques include tarsoconjunctival grafts, spacers, midface lift, and lateral canthal tendon suspension, although no single procedure has been universally recognized as the gold standard. New innovations such as synthetic grafts and xenografts are being explored for their potential in eyelid reconstruction. Severe cases, defined as those with inferior scleral show greater than 2 mm, may require a combination of reconstruction methods. CONCLUSIONS:Correcting cicatricial lower eyelid retraction is a major challenge in oculoplastic reconstruction. The surgical approach should be individualized, considering the pathologies and etiologies of lid retraction. In-depth knowledge and careful surgical planning are essential for best outcomes. There is no gold standard technique, and postoperative outcomes, complications, and management vary depending on the surgical approach used.

Purpose:To assess subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) profile in the Iranian healthy population and assessment of the inter-eye difference in this regard. Methods:In a cross-sectional study, 141 healthy subjects underwent an assessment of refraction and best-corrected visual acuity (BCVA), axial length (AL), and measurement of the intraocular pressure. The imaging of the choroid was performed using the enhanced-depth imaging mode of Spectralis optical coherence tomography from the foveal slab to measure SFCT and calculate CVI. Results:A total of 282 eyes of 141 healthy subjects (59.6% men, mean age of 60.86 ± 11.46 years) enrolled in the current study. The mean SFCT of the right and left eye was 247.40 ± 70.37 and 251.25 ± 72.19, respectively. The mean CVI of the right and left eye was 62.63 ± 3.77 and 63.19 ± 3.91, respectively. None of the measured parameters had statistically significant differences between the left and right eyes. In both univariate and multivariate regression analysis, CVI was significantly associated with BCVA (P < 0.001) but was not associated with age, spherical equivalent (SE), gender, central macular thickness (CMT), and SFCT. In univariate regression analysis, SFCT was significantly associated with age, refraction (P = 0.02), BCVA (P = 0.003), AL (P < 0.001), and CVI (P = 0.02) but not significantly associated with gender and CMT. In multivariate analysis, age (P < 0.001), gender (P = 0.001), and AL (P < 0.001) were significantly associated with SFCT, but SE, BCVA, CVI, and CMT were not significantly associated. Conclusions:This was the first investigation to assess the SFCT and CVI simultaneously in the Iranian population to establish a normative database for future studies. CVI was less variable than SFCT in a healthy population, and no statistically significant differences existed between the left and right eyes.

BACKGROUND:The aim of this report is to highlight the importance of considering nephrotic syndrome as a potential underlying cause of bilateral central serous retinal detachment in a patient with systemic lupus erythematosus and to underscore the significance of a comprehensive systemic workup in these patients.CASE PRESENTATION:A 19-year-old Iranian female patient with history of systemic lupus erythematosus presented with progressive vision loss and bilateral macular elevation. Ophthalmic examination revealed periorbital edema, chemosis, and subretinal fluid at the macula of both eyes. Optical coherence tomography confirmed the existence of subretinal fluid and serous detachment located at the macula of both eyes. On fluorescein angiography, there were no signs of subretinal leakage such as smoke stack sign or expansile dot in late phases. Laboratory tests detected hypoalbuminemia and significant proteinuria, leading to the diagnosis of nephrotic syndrome. Treatment with prednisolone and albumin infusion resulted in improved visual acuity and resolution of subretinal fluid.CONCLUSION:Nephrotic syndrome can be a rare underlying cause of bilateral central serous retinal detachment, and its association with systemic lupus erythematosus should be considered. Hypoalbuminemia in nephrotic syndrome alters fluid dynamics in the retina, contributing to bilateral central serous retinal detachment. Early recognition and management of nephrotic syndrome are essential for vision recovery and preventing long-term complications.

PURPOSE To investigate clinical manifestations and prognoses in pediatric patients (#12 years old) with ocular melanoma.METHODS This was a retrospective, multicenter cohort study with individual participant data (IPD) meta-analysis pooling available published cases, and unpublished cases from an international collaboration of seven ocular oncology centers.RESULTS There were 133 eyes of 133 pediatric patients with choroidal or ciliary body (n = 66 [50%]), iris (n = 33 [25%]), conjunctival (n = 26 [19%]), and eyelid (n = 8 [6%]) melanoma. Overall, the mean patient age at presentation was 7 years (median, 8; range, 1-12 years), with 63 males (49%). The mean age by tumor site was 6.50 +/- 3.90, 7.44 +/- 3.57, 9.12 +/- 2.61, and 5.63 +/- 2.38 years, for choroid/ciliary body, iris, conjunctiva, and eyelid melanoma, respectively (P = 0.001). Association with ocular melanocytosis was seen in 15%, 11%, 4%, and 0%, respectively (P = 0.01). Frequency of ocular melanoma family history did not vary by tumor site (7%, 17%, 9% and 12%, resp. [P = 0.26]). After mean follow-up of 74, 85, 50, and 105 months (P = 0.65), metastasis was seen in 12%, 9%, 19%, and 13% of choroid/ciliary body, iris, conjunctiva, and eyelid melanoma, respectively. Death was reported in 5%, 3%, 8%, and 0%, respectively, with survival analysis indicating higher mortality in choroidal/ciliary body and conjunctival melanoma patients.CONCLUSIONS Ocular melanoma in the pediatric population is rare, with unique clinical features and outcomes. Iris melanoma accounts for about one-third of pediatric uveal melanoma cases. ( J AAPOS 2023;27:316-324)

Purpose: To evaluate the epidemiologic pattern of intravitreal injections (IVIs) during Coronavirus Disease 2019 (COVID-19) pandemic. Methods: The records of patients receiving IVIs in two 12-month periods immediately before and after the beginning of the COVID-19 epidemic were included. Age, province of residency, indication, number of injections, and number of operating room (OR) visits were analyzed. Results: Compared to pre-COVID period, a 37.6% decrease in the number of patients receiving IVI in COVID period was seen (10518 vs. 6569). There was a parallel decrease in the number of OR visits (25590 vs. 15010: 41.4%) and injections (34508 vs. 19879: 42.4%). Regarding IVI indication, age-related macular degeneration (AMD) showed the highest decrease in IVI rate (46.3%) which was significantly higher than decrease in other indications (P < 0.001). Retinopathy of prematurity (ROP) patients showed no change after epidemic. Mean overall age in AMD group was the highest (67.7 ± 13.2 years) compared to other indication groups (excluding ROP) (P < 0.001); while the mean age of the other indications was not significantly different from each other (excluding ROP). Conclusions: COVID pandemic decreased the number of IVIs significantly. While previous studies suggested that the AMD patients had the highest risk of visual loss due to failure to receive IVIs in a timely manner, this very same group showed the highest decrease in the IVI number after pandemic. The health systems should devise strategies to protect this most vulnerable group of patients in future similar crises.

Retinitis pigmentosa (RP) is an inherited bilateral retinal degenerative disease with an incidence of 1 in 4000 people. RP affects more than 1 million individuals worldwide. Although night blindness and restricted visual field are the most typical symptoms of these individuals, generalized vision loss due to cataracts can be expected in the latter stages of the disease. It has been demonstrated that posterior subcapsular cataract is the most prevalent cataract in younger individuals with RP, as opposed to age-related cataracts. Although most ophthalmologists may have a negative view of cataract surgery in patients with RP, it appears that it can play an important role in the visual restoration of patients with RP. However, there are concerns about performing cataract surgery for patients with RP. Herein, a systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses on databases of MEDLINE and Scopus.

PURPOSE:The study aims to classify the eyes with proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR) based on the optical coherence tomography angiography (OCTA) vascular density maps using a supervised machine learning algorithm.METHODS:OCTA vascular density maps (at superficial capillary plexus (SCP), deep capillary plexus (DCP), and total retina (R) levels) of 148 eyes from 78 patients with diabetic retinopathy (45 PDR and 103 NPDR) was used to classify the images to NPDR and PDR groups based on a supervised machine learning algorithm known as the support vector machine (SVM) classifier optimized by a genetic evolutionary algorithm.RESULTS:The implemented algorithm in three different models reached up to 85% accuracy in classifying PDR and NPDR in all three levels of vascular density maps. The deep retinal layer vascular density map demonstrated the best performance with a 90% accuracy in discriminating between PDR and NPDR.CONCLUSIONS:The current study on a limited number of patients with diabetic retinopathy demonstrated that a supervised machine learning-based method known as SVM can be used to differentiate PDR and NPDR patients using OCTA vascular density maps.

Abstract Purpose: To describe spectral-domain optical coherence tomography (SD-OCT) morphological characteristics in patients with cone dystrophy. Methods: Forty-two patients (84 eyes) with the diagnosis of cone dystrophy based on clinical findings and electroretinogram reports (severely reduced or non-recordable cone response with preserved rod function) were included in our study. SD-OCT was performed and images were evaluated regarding the integrity and pattern of hyper-reflective outer retinal bands and other findings. The relationship between these findings, age, central subfoveal thickness (CST), and best-corrected visual acuity (BCVA) was assessed. Results: 82 of 84 eyes (98 %) showed outer retinal layer abnormalities on SD-OCT. Five different morphological categories were identified on SD-OCT, including outer retinal atrophy (24.4%), undifferentiated outer retinal layers (22.0%), ellipsoid zone (EZ) disruption (19.5%), outer foveal defect (17.1%), and prominent outer retinal layers (17.1%). Also, five isolated OCT findings were detected, including foveal hypoplasia (14.6%), trans-retinal hyperreflective dots (THD) (29.3%), outer plexiform layer (OPL) schisis (11.3%), pseudodrusen (9.8%), and EZ bowing (13.4%). Age and CST were significantly different across the morphological categories (p<0.001). Eyes with prominent outer retinal layers and outer retinal atrophy had the best and worst visual acuity, respectively; however, the difference was not significant (p=0.16). Conclusion: SD-OCT imaging shows variety of morphologic findings in cone dystrophy, which may be utilized in the assessment of these patients and may serve as predictive biomarkers for VA.

Tamoxifen (TAM) is a selective estrogen receptor modulator that is used in the treatment of breast cancer. As there are estrogen receptors in the retina, retinal pigment epithelium, and choroid, these tissues may also be affected by TAM. We describe the reported effects of TAM on the retina and choroid. Medical databases were searched using relevant keywords and the results were extracted and pooled. The incidence of retinal/choroidal toxicity ranged from 0.9% to 12%. There was a wide range for the time of exposure before the development of TAM retinopathy (3 weeks to 13 years). While functional measurements may be appropriate for assessment of TAM retinopathy, they have not been effective for screening patients. There is no generally accepted screening modality, but serial funduscopy and optical coherence tomography imaging seem to be the most reasonable approach for detecting early TAM-induced retinal toxicity.

Purpose To report on the efficacy of early pars plana vitrectomy (PPV), silicone oil (SO) tamponade, and intravitreal ganciclovir injection in the treatment of a case with progressive outer retinal necrosis (PORN). Case Presentation. A 33-year-old man with a history of shingles on the chest skin 2.5 months ago presented with progressive vision loss in both eyes over the past 20 days. Fundus examination revealed retinal necrosis with perivascular clearance. Human immunodeficiency virus (HIV) infection was confirmed by western blot analysis. Treatment with intravenous acyclovir and intravitreal ganciclovir injections was unable to stop the progression of retinitis. Along with highly active antiretroviral therapy, the patient underwent PPV with SO tamponade and intravitreal ganciclovir injection in both eyes. A few days after surgery, retinal lesions started to improve. Conclusion Early PPV, SO tamponade, and intravitreal ganciclovir injection may be considered an effective intervention in PORN patients with an unfavorable response to medical treatment.

PURPOSE: To investigate the short-term functional and microstructural outcomes of pars plana vitrectomy (PPV) without gas tamponade in lamellar macular holes (LH). MATERIALS AND METHODS: In this prospective case series, LH cases diagnosed by optical coherence tomography (OCT) underwent PPV with epiretinal membrane (ERM) removal and internal limiting membrane peeling without gas tamponade. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) and OCT imaging preoperatively and 3 months after the surgery. RESULTS: Among 22 eyes, 10 degenerative (Deg) LH, 8 tractional (Trac) LH, and 4 mixed-type LH were assessed. After the surgery, anatomical closure occurred in 20 eyes (91%) without any significant difference between LH subgroups. Comparing preoperative and postoperative values, no significant changes was detected regarding BCVA neither totally (P = 0.5) nor in subgroups (P for Deg = 1.0, Trac = 0.71, Mix = 0.18). The overall central foveal thickness was increased significantly after surgery (P < 0.01), but in subgroup analysis, the increase was significant only for Trac LH (P = 0.02). The tractional LH eyes had less ellipsoid zone (EZ) disruptions compared to Deg or mixed subgroups before surgery. There were no changes in EZ integrity before and after the surgery. In regression analysis, no correlation was found between demographic or clinical characteristics and anatomical closure or BCVA improvement postoperatively. CONCLUSION: PPV resulted in 91% anatomical closure of all cases of LH but without functional improvement in short-term. Further prospective clinical trials with larger sample size and longer follow-up would be required to confirm the clinical significance of these findings.

AbstractIntroduction:To evaluate and compare macular vasculature changes in 1 and 3-months after initiating treatment with either panretinal photocoagulation (PRP) or Intravitreal bevacizumab (IVB) injection.Methods: A total of 62 eyes from 33 diabetic patients without macular edema were included in this prospective case series. Of these, thirty-nine eyes (21 patients) were allocated to the PRP group, while 23 eyes (12 patients) were treated with IVB biosimilar (Stivantâ). Optical tomography angiography (OCTA) was performed to measure foveal avascular zone (FAZ) characteristics as well as superficial (SCP) and deep vascular plexus (DCP) densities.Results: After the initiation of IVB injections, the FAZ area and Perimeter expanded modestly at month 1 but returned to baseline level after three months. In the PRP group, however, FAZ area and Perimeter were rather steady. FAZ area changes were significantly different between treatment groups at month 1 (p=0.02), but not at month 3 (p=0.31). The comparison of two groups based on mean FAZ perimeter change revealed a significant difference at month 1, but no significant difference at month 3 (p=0.03 and p=0.48, respectively). There was no significant difference in the FAZ circularity index change between the two groups at each timepoints (p=0.55 and p=0.31). The foveal vessel density changes in the SCP were not statistically significant between the two groups, at both month 1 and 3 (all P>0.05). A comparison of two treatment arms based on mean DCP density change revealed a significant difference at month 1, but not at month 3 (p=0.01 and p=0.49, respectively).Conclusion: Some vascular metrics changes in OCTA (e.g., FAZ area, Perim, Foveal DCP vascular density) may be significantly different between two types of therapies in the very early short-term (1 month) after treatment initiation. In the third month following treatment, all of these differences diminished to insignificance.

Recently, endothelial keratoplasty (EK) has been increasingly considered the first intervention in pediatrics with isolated corneal endothelial dysfunction. This systematic review aims to investigate the current evidence about the advantages, disadvantages, technical challenges, and clinical outcomes of EK in the pediatric group. All the English literature relevant to pediatric EK was searched in PubMed, Embase, Scopus, and Cochrane databases with appropriate keywords. Relevant data were pooled to conduct an individual participant data meta-analysis. Of 1646 articles found initially, 35 articles were finally eligible to be included in our study. A total of 154 eyes of 107 patients underwent Descemet’s stripping automated endothelial keratoplasty (DSAEK). Congenital hereditary endothelial dystrophy (CHED) was the most reported indication for pediatric DSAEK (108 eyes). Descemet’s membrane endothelial keratoplasty (DMEK) was performed in 2 eyes of 2 cases, one with PPCD and another one in a patient with Kearns–Sayre syndrome. Owing to some specific anatomical and physiological pediatric characteristics, some modifications in a standard procedure were suggested. The average follow-up period was 23.80 ± 20.18 months (3 months to 8.5 years). Seventy-six eyes who had a mean best-corrected visual acuity (BCVA) of 1.36 ± 0.70 (0.49 to 3) logMAR preoperatively found mean BCVA of 0.51 ± 0.33 (0.04 to 2) logMAR postoperatively. Graft dislocation was the most reported complication (26 eyes). The rate of other complications was low. Endothelial cell loss was reported from 8.3 to 63.7% after pediatric EK with follow-up duration from 3 months to 8.3 years. EK procedures, despite some technical challenges, are feasible surgical techniques with acceptable visual and anatomical outcomes in the management of pediatrics with corneal endothelial dysfunction and minimal stromal involvement.

Background To evaluate the additive effect of topical or sub-tenon injection of interferon (IFN)-α 2b in the treatment of refractory diabetic macular edema. Methods In this prospective study patients with center-involved DME who were unresponsive to 3 monthly consecutive IVB injections were recruited. Patients were divided into three groups: group1, received IFN- α 2b topical drop at a dose of 1mIU/ml four times a day for 3 months. Group 2, received a single sub-tenon injection of 1mIU/ml IFN- α 2b at the enrollment. Group 3 received artificial tears four times a day for 3 months (control group). All groups received three consecutive monthly IVB injections and were evaluated monthly up to 1 month following the last IVB injection. Results In this study, 59 eyes of 35 patients with refractory DME were assessed. The final follow-up showed that although CMT decreased in all groups, only patients in Group 2 had statistically significant lower CMT compared to their baseline values (change in CMT: − 117 ± 213 µm; p-value = 0.025). Comparison of CMT changes between three groups showed no statistically significant difference, although it was higher in group 2 (change in CMT: − 117 ± 213 µm (Group2) vs. − 49 ± 173 (Group 1) vs. − 36 ± 86 (Group 3); p-value = 0.085). Considering eyes with baseline CMT > 400 µm, sub-tenon injection of IFN α2b led to a significant reduction of CMT at the first month and final follow-up visit (CMT change: − 166 ± 210, − 145 ± 231 µm; p-value = 0.018 and 0.035, respectively). In this subgroup, eyes in Group 2 had lower CMT at the first month following treatment in comparison with the control group (CMT: 444 ± 123 µm vs. 544 ± 96 µm, p-value = 0.042). Alterations of CDVA were not statistically significant among groups, although patients in Group 1 had a significant improvement in vision at second and last follow up (CDVA change: − 0.23 ± 0.39, − 0.20 ± 0.43 logMAR; p-value = 0.030 and 0.010, respectively). Conclusions In short term, Sub-tenon injection of IFN might have an additive anatomical effect in eyes with refractory DME. Validation of this observation requires further prospective controlled studies.

The effect of reserpine and 6-hydroxydopamine on the learned conditioned natural killer (NK) cell response was investigated in mice. Reserpine given at 2.5 mg/kg, 24 hr prior to reexposure to camphor-conditioned stimulus on days 6 and 8 blocked the recall of conditioned NK cell response to a significant extent. In other words, the NK cell activity of conditioned mice, treated with reserpine and reexposed to the conditioned stimulus, was similar to the nonconditioned (NC) group. A conditioned increase in NK cell response was still evident in mice treated with 6-OHDA.