Multiple sclerosis (MS) presents with optic neuritis (ON) in 20 % of cases and 50 % of ON patients develop MS within 15 years. In this study, we evaluated the preventive effects of vitamin D3 administration on the conversion of ON to MS (primary outcome) and on the MRI lesions (secondary outcome) of ON patients with low serum 25 (OH) D levels. Thirty ON patients (15 in each of 2 groups, aged 20-40 years) with serum 25 (OH) D levels of less than 30 ng/ml were enrolled in a double blind, randomized, parallel-group trial. The treatment group (cases) received 50,000 IU of vitamin D3 weekly for 12 months and the control group (controls) received a placebo weekly for 12 months. Finally, the subsequent relapse rate and changes in MRI plaques were compared between the two groups. Risk reduction was 68.4 % for the primary outcome in the treatment group (relative risk = 0.316, p = 0.007). After 12 months, patients in the treatment group had a significantly lower incidence rate of cortical, juxtacortical, corpus callosal, new T2, new gadolinium-enhancing lesions and black holes. The mean number of total plaques showed a marginally significant decrease in the group receiving vitamin D3 supplementation as compared with the placebo group (p = 0.092). Administration of vitamin D3 supplements to ON patients with low serum vitamin 25 (OH) D levels may delay the onset of a second clinical attack and the subsequent conversion to MS.

Although two imaging technologies had statistically numerical different output, it seems that they have a good agreement in most parameters.

Patients suffering from Urbach-Wiethe syndrome (UWS), also known as lipoid proteinosis or hyalinosis cutis et mucosae, may have an ophthalmologist involved in the diagnosis and management of their disease. Along with moniliform blepharosis as a pathognomonic feature of the disease, an ophthalmologist may encounter other manifestations of UWS in any part of the eye such as cornea; conjunctiva; sclera; trabecular meshwork; iris/pupil; lens and zonular fibers; retina; nasolacrimal duct. This paper provides a review on the pathogenesis and the diverse ocular manifestations seen in UWS patients. Uncommon complications are discussed in this paper (glaucoma; dry eye and epiphora; complications of lens, retina, cornea; iris/pupil and conjunctiva). Moreover, a 27-year-old male UWS patient is described with bilateral diffuse anterior stromal iris atrophy, diffuse keratic precipitates; posterior subcapsular cataract; 1 + vitreous cell in anterior vitreous examination. This case was thought to be the first instance of bilateral uveitis associated with UWS. Overall, ophthalmologists may encounter diverse ocular complications accompanying this syndrome. They should be familiar with well-established ophthalmologic manifestations leading them to cooperate with other specialists in diagnosis and management of the disease.

The aim of this study is to evaluate the short-term effects of a single intravitreal injection of 1.25 mg Bevacizumab combined with 300 lg/0.1 mL Diclofenac (IVB/D) versus 1.25 mg intravitreal Bevacizumab (IVB) alone in the treatment of naive diabetic macular edema (DME). In this prospective, randomized clinical trial, 80 eyes were included in the final analysis; 42 and 38 of which in the IVB and IVB/D groups, respectively. The primary outcome measure was a change in best-corrected visual acuity (BCVA) in logMAR at week 4. The secondary outcomes included changes in central macular thickness (CMT), macular volume, and potential injection-related complications. Significant improvement of BCVA was demonstrated in both study arms (mean reductions in LogMAR: -0.088 ± 0.278, -0.228 ± 0.330 for IVB and IVB/D, respectively). The difference in BCVA changes was in favor of IVB/D; however, not to a statistically significant level (P = 0.160). Significant reduction of CMT was documented in both study arms (mean reductions: 82.43 ± 160.09 and 153.26 ± 163.85 for IVB and IVB + IVD, respectively). Comparison of CMT changes between groups showed that IVB/D reduced CMT more than that of IVB (P = 0.04). Effects on macular volume corresponded to those of CMT. No injection-related complications or significant alterations in intraocular pressure were observed in any of the study arms. In treatment-naive DME, superiority of IVB/D combination therapy over IVB monotherapy may exist; especially as regards anatomical features. In our therapeutic arsenal for DME, IVD can be added as an adjunct to Bevacizumab.

Editor:We read with great interest the recent paper by Kumar and colleagues 1 describing two cases of topiramate (TPM)-induced cilio-choroidal effusion syndrome (TiCCES) with retinal complications. In a recent systematic review of 74 available studies, we provided a classification for TPM-induced visual side-effects, 2 and herein would like to draw the kind attention of the reader toward the specific effects of TPM on the retina.As a definition, TiCCES is the spectrum of signs and symptoms ranging from transient 'topiramate-induced myopic shift' to bilateral 'topiramate-induced angleclosure glaucoma'. 2 The two interesting cases presented by the authors 1 necessitate highlighting the notion that TiCCES may accompany retinal complications due to the process of choroidal effusion throughout the posterior segment. As postulated by Guier 3 during the process of TiCCES, choroidal thickening and the resulting decrease in the area of Bruch's membrane/retinal pigment epithelium can cause retinal redundancy and consequent retinal folds or striae. This complication may even occur more severely, for example, the condition we described in our case where topiramate-induced massive bilateral choroidal effusion resulted in elevation of the retina. 4 Hence, the process of topiramate-induced ciliochoroidal effusion per se can be identified as an intermediating component between use of TPM and retinal complications. The nature of TiCCES is supposed to be related to idiosyncratic reactions presented during the first two weeks of drug initiation or dose doubling. 2,[5][6][7] This underlines the important point that TiCCES-related retinal side effects usually occur by transient exposure to low doses of the drug. In the literature, there are four cases that describe TiCCES-related retinal striae within one to 14 days (median of six days) of taking the drug at doses of 25 to 100 mg/day (median 50). 2Of note, this figure is similar to the characteristics of the overall TiCCES cases which we reviewed. Moreover, the spectrum of retinal effects of TPM expands to its possible direct effects on the histopathology and function of retinal cells and in particular, retinal ganglion cells.8 There are some clinical and experimental studies exploring the features and mechanisms of the direct effects of TPM on the retina. 2,7Existing literature lacks a convincing consensus on this subject; 8 however, three cases of TPM-related maculopathy and one with visual field defects provide objective evidence in support of direct adverse effects of TPM on the retina.2 These cases developed such conditions within two to 156 weeks (median 10 weeks) of taking the drug at doses of 125 to 400 mg/day (median 150 mg/day). These effects are not seemingly associated with the idiosyncratic process of TiCCES and occur following repeated exposure to TPM with probably higher doses than reported in TiCCES (median dose in 44 previous TiCCES cases was 50 mg/day).2 As a conclusion, we suggest classifying retinal effects of topiramate into two categories; First, acute complica...