1
|
Liang KH, Tsai HR, Peng PL, Chen CH, Huang YT, Lu JW, Chen TL. Combined phacovitrectomy versus sequential surgery for idiopathic macular holes: systematic review and meta-analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e252-e259. [PMID: 37253430 DOI: 10.1016/j.jcjo.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/12/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To compare the best-corrected visual acuity (BCVA) change, idiopathic macular (IMH) closure, and complications in IMH patients receiving combined phacovitrectomy and sequential surgery (vitrectomy followed by phacoemulsification). DESIGN Systematic review and meta-analysis. METHODS PubMed, Ovid EMBASE, and Cochrane Library databases were searched from their inception through February 2022. Randomized, controlled trials and observational studies that presented results of BCVA change, IMH closure, and surgery-related complications were included. A random-effects meta-analysis was conducted to calculate effect estimates with 95% CIs. RESULTS One randomized, controlled trials and 7 cohort studies with 585 patients were included. Overall, the meta-analyses of BCVA change (mean difference, -0.03; 95% CI, -0.10-0.04) and IMH closure (risk ratio = 1.04; 95% CI, 0.96-1.13) revealed no significant differences between combined phacovitrectomy and sequential surgery. The pooled risk ratios for various surgical complications such as postoperative retinal detachment, inflammation, and intraocular pressure elevation showed no significant differences between the 2 groups. CONCLUSIONS Similar visual gain and IMH closure rates were achieved after both combined phacovitrectomy and sequential surgery, with similar complication risks. The anatomic and functional outcomes of combined surgery were not better than those of sequential surgery. These results could serve as a reference for future trials.
Collapse
Affiliation(s)
- Kai-Hsiang Liang
- Department of Medical Education, Medical Administration Office, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hou-Ren Tsai
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Medical Education, Medical Administration Office, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Po-Lin Peng
- Department of Medical Education, Medical Administration Office, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chih-Hao Chen
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Ting Huang
- Department of Medical Education, Medical Administration Office, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jing-Wun Lu
- Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tai-Li Chen
- Department of Medical Education, Medical Administration Office, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
| |
Collapse
|
2
|
Lima-Fontes M, Leuzinger-Dias M, Barros-Pereira R, Fernandes V, Falcão M, Falcão-Reis F, Rocha-Sousa A, Alves-Faria P. Intravitreal Fluocinolone Acetonide Implant (FAc, 0.19 mg, ILUVIEN®) in the Treatment of Patients with Recurrent Cystoid Macular Edema After Pars Plana Vitrectomy. Ophthalmol Ther 2023; 12:377-388. [PMID: 36417092 PMCID: PMC9834446 DOI: 10.1007/s40123-022-00613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Postoperative cystoid macular edema (PCME) is a complication of several ocular procedures, including pars plana vitrectomy (PPV), due to the activation of the inflammatory cascade. The purpose of this case series is to evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (FAc, 0.2 μg/day; ILUVIEN®) in the treatment of refractory PCME after successful PPV. METHODS This retrospective observational case series includes consecutive eyes of patients with recurrent PCME after PPV and treated with a single FAc implant at Centro Hospitalar Universitário de São João, Porto, Portugal. Previous treatments, best-corrected visual acuity (BCVA, ETDRS letters), central macular thickness (CMT, μm), intraocular pressure (IOP, mmHg), and IOP-lowering medication needed were recorded at baseline and during follow-up. Total macular edema resolution was defined as CMT less than 300 μm or a reduction of greater than 20%, and partial macular edema resolution was defined as a reduction of greater than 10%. RESULTS Nine eyes from nine patients were included. Before FAc implant, all eyes received intravitreal short-action corticosteroids (triamcinolone and dexamethasone implant), with a good response but relapse 1-5 months later. At baseline, BCVA was 55.0 ± 10.6 letters, CMT was 514.9 ± 165.6 μm, and IOP was 15.4 ± 2.4 mmHg with four eyes under IOP-lowering medication. After FAc implant, all eyes achieved edema resolution (eight total and one partial) with a peak gain of 17.2 letters and a maximum decrease of 208.2 μm in CMT. During follow-up (44.0 ± 14.8 months), 66.7% of the eyes kept their macula dry and three showed recurrence after 11, 14, and 28 months, respectively. The maximum IOP registered was 17.0 ± 6.0 mmHg. IOP-lowering regimen was increased in one eye and two additional eyes started hypotensive drops. CONCLUSION FAc implant can be considered a therapeutic alternative in PCME refractory to other therapies in vitrectomized eyes, reducing the need for repeated treatments.
Collapse
Affiliation(s)
- Mário Lima-Fontes
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mariana Leuzinger-Dias
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ricardo Barros-Pereira
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Vítor Fernandes
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Manuel Falcão
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Alves-Faria
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
3
|
BILATERAL INTRAVITREAL 0.19-MG FLUOCINOLONE ACETONIDE IMPLANT FOR PERSISTENT NONDIABETIC CYSTOID MACULAR EDEMA AFTER VITRECTOMY. Retin Cases Brief Rep 2021; 15:261-265. [PMID: 30015770 DOI: 10.1097/icb.0000000000000779] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE Iluvien (Alimera Science, Alpharetta, GA) is an injectable, nonbiodegradable, sustained-release 0.19-mg fluocinolone acetonide intravitreal implant. Although currently approved by the Food and Drug Administration only for diabetic macular edema previously treated with a course of corticosteroids without a clinically significant intraocular pressure response, the 0.19-mg fluocinolone acetonide implant could theoretically be used to treat other noninfectious inflammatory conditions including persistent cystoid macular edema because of nondiabetic etiologies. METHODS Interventional case report. A 79-year-old man had persistent cystoid macular edema after pars plana vitrectomy in both eyes that was refractory to topical treatments and intravitreal anti-vascular endothelial growth factor. His cystoid macular edema was responsive to preservative-free intravitreal triamcinolone acetonide after which he developed noninfectious endophthalmitis or pseudoendophthalmitis in both eyes precluding further intravitreal triamcinolone acetonide injections. He was subsequently treated with bilateral intravitreal 0.19-mg fluocinolone acetonide implants. RESULTS At the most recent post-treatment follow-up (11 months for the right eye and 13 months for the left eye), the patient demonstrated an improvement in visual acuity, 20/126 to 20/50 in the right eye and 20/80 to 20/40 in the left eye, and in central subfield thickness, 592 μm to 288 μm in the right eye and 565 μm to 287 μm in the left eye, without intraocular pressure elevation. CONCLUSION The intravitreal 0.19-mg fluocinolone acetonide implant is an effective and potentially safe off-label therapeutic option for persistent nondiabetic cystoid macular edema after vitrectomy.
Collapse
|
4
|
[Statement of the Professional Association of German Ophthalmologists (BVA), the German Ophthalmological Society (DOG) and the Retinological Society (RG) on the development, diagnostics and treatment of epiretinal gliosis : Status October 2020]. Ophthalmologe 2021; 118:121-138. [PMID: 33346894 DOI: 10.1007/s00347-020-01291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
5
|
Busquets MA, Lutz CT, Zhao T. Management of Cystoid Macular Edema After Vitrectomy for Proliferative Vitreoretinopathy. Ophthalmic Surg Lasers Imaging Retina 2020; 51:436-443. [PMID: 32818275 DOI: 10.3928/23258160-20200804-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess therapies for cystoid macular edema (CME) following pars plana vitrectomy for proliferative vitreoretinopathy (PVR). PATIENTS AND METHODS Retrospective analysis of 42 eyes developing CME after PVR surgery. Treatments included topical therapy, sub-Tenon's triamcinolone acetonide (STTA), intravitreal bevacizumab and combinations thereof. Best-corrected visual acuity (BCVA) as well as central subfield thickness (CST) were tracked. RESULTS Mean Snellen BCVA improved from 20/598 to 20/297 (logMAR change -0.21; confidence interval [CI], -0.39 to -0.03; P = .03). Mean CST improved from 448 µm to 260 µm (CI, -248.70 to -126.06; P < 0.01). There was no difference in efficacy between treatment subgroups (analysis of variance, P = 0.16, 0.43), but STTA yielded statistically significant improvement in both categories (CI, -0.79 to -0.11; P = 0.01; and CI, -333.74 to 166.51; P < .01). CONCLUSIONS Treatment of CME following PVR surgery is possible with a variety of different options. STTA appears to yield anatomical and visual improvement. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:436-443.].
Collapse
|
6
|
Inner Retinal Layer and Outer Retinal Layer Findings after Macular Hole Surgery Assessed by means of Optical Coherence Tomography. J Ophthalmol 2019; 2019:3821479. [PMID: 31061725 PMCID: PMC6466935 DOI: 10.1155/2019/3821479] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/24/2019] [Indexed: 11/18/2022] Open
Abstract
Aim To summarize the spectrum of optical coherence tomography (OCT) and OCT angiography (OCTA) features after full-thickness macular hole (MH) repair surgery. Methods A PubMed engine search was carried out using the terms "Macular Hole," "Optical Coherence Tomography," and "Optical Coherence Tomography Angiography." All reports published in English up to October 2018, irrespective of their publication status, were included. Tomographic signs analyzed were divided according to the involved portion of the retina in "inner retinal layers" and "external retinal layers." Despite predominantly involving the inner retinal layers, cystoid macular edema (CME) has been treated as a separate entity. Finally, report on vessel density (VD) changes and the foveal avascular zone (FAZ) area modifications have been included. Results Different clinical findings can be observed on OCT of patients who underwent MH repair surgery. There is general consent that retinal thinning involving primarily the retinal nerve fiber layer and the ganglion cell layer takes place after surgery. In the postoperative period, the outermost retinal layers get progressively restored. Persistent defects in the ellipsoid zone or in the external limiting membrane correlate with worse postoperative visual outcome. OCTA has globally demonstrated that eyes after MH closure show a reduction in macular and paramacular VD and smaller FAZ areas, compared with control or fellow eyes. Conclusion Clinicians should be aware of the most common tomographic findings to properly manage each condition. In addition, significant advantages for the postoperative application of OCT and OCTA include noninvasiveness, rapid and simple execution, repeatability, and precise measurements.
Collapse
|
7
|
Yonekawa Y, Mammo DA, Thomas BJ, Wolfe JD, Hassan TS. A Comparison of Intraoperative Dexamethasone Intravitreal Implant and Triamcinolone Acetonide Used During Vitrectomy and Epiretinal Membrane Peeling: A Case Control Study. Ophthalmic Surg Lasers Imaging Retina 2016; 47:232-7. [DOI: 10.3928/23258160-20160229-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/19/2016] [Indexed: 11/20/2022]
|
8
|
Hattenbach LO, Kuhli-Hattenbach C, Springer C, Callizo J, Hoerauf H. Intravitreales Dexamethason-Implantat zur Behandlung des persistierenden postoperativen Makulaödems nach Vitrektomie. Ophthalmologe 2016; 113:581-8. [DOI: 10.1007/s00347-016-0223-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
9
|
Intravitreal dexamethasone implant for refractory macular edema secondary to vitrectomy for macular pucker. Retina 2014; 34:1612-6. [PMID: 24752008 DOI: 10.1097/iae.0000000000000105] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the efficacy of a single 0.7 mg dexamethasone intravitreal implant in vitrectomized eyes with refractory macular edema secondary to combined cataract extraction and macular pucker removal. METHODS In 8 eyes of 8 consecutive patients with refractory macular edema secondary to combined cataract extraction and 25-gauge vitrectomy with internal limiting membrane peeling for macular pucker removal, the injection of the 0.7 mg dexamethasone implant was performed. Best-corrected visual acuity, central retinal thickness measured by spectral domain optical coherence tomography, and intraocular pressure were evaluated at baseline, 1 month, and 6 months. RESULTS After a mean follow-up of 6.75 ± 0.71 months, best-corrected visual acuity was significantly increased (P < 0.0001) from 20/50 to 20/23 (P < 0.0001), mean central retinal thickness decreased significantly from 439 ± 45 μm to 296 ± 49 μm (P < 0.0001), and intraocular pressure changed significantly (P = 0.02) from 14.63 ± 1.19 to 16 ± 0.93. In no case postoperative hypotony or other complication was observed. CONCLUSION A single injection of the 0.7 mg dexamethasone intravitreal implant resulted effective in the treatment of refractory macular edema secondary to combined cataract extraction and vitrectomy for macular pucker removal allowing a stable visual acuity recovery.
Collapse
|
10
|
Parke DW, Sisk RA, Murray TG. Intraoperative intravitreal triamcinolone decreases macular edema after vitrectomy with phacoemulsification. Clin Ophthalmol 2012; 6:1347-53. [PMID: 22969279 PMCID: PMC3429292 DOI: 10.2147/opth.s34653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to evaluate the incidence and amount of macular edema by optical coherence tomography (OCT) after combined small gauge sutureless vitrectomy with phacoemulsification and intravitreal triamcinolone. Methods This retrospective case series included 194 consecutive eyes undergoing nonemergent vitrectomy with phacoemulsification and intravitreal triamcinolone. Ninety-one eyes had preoperative and postoperative OCT available and were included in the analysis. The eyes were evaluated for retinal thickness with preoperative and postoperative OCT, and for preoperative and postoperative best-corrected visual acuity. The main outcome measures were retinal thickness, OCT appearance, and best-corrected visual acuity. Results The incidence of macular edema in all eyes preoperatively was 64.8% and postoperatively was 50.5%. Mean central subfield and center point thickness in eyes with macular edema preoperatively were 361 μm and 349 μm, respectively, and postoperatively were 315 μm and 304 μm, respectively. In eyes without preoperative macular edema, mean preoperative central subfield and center point thickness were, respectively, 210 μm and 181 μm versus 220 μm and 192 μm postoperatively. Best corrected visual acuity improved from 20/190 preoperatively to 20/150 at postoperative month 1 and 20/110 at month 6. Postoperative intraocular pressure ≥ 25 mmHg was observed in 7.7% of eyes, none of which required surgical intervention for steroid-induced glaucoma. Conclusion Use of intravitreal triamcinolone with combined vitrectomy and phacoemulsification may play an important role in modulating postoperative macular edema. Adverse pressure rise is infrequent and usually limited.
Collapse
Affiliation(s)
- D Wilkin Parke
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | | |
Collapse
|
11
|
Shen L, You Y, Sun S, Chen Y, Qu J, Cheng L. Intraocular and systemic pharmacokinetics of triamcinolone acetonide after a single 40-mg posterior subtenon application. Ophthalmology 2010; 117:2365-71. [PMID: 20678801 DOI: 10.1016/j.ophtha.2010.03.033] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Revised: 03/10/2010] [Accepted: 03/11/2010] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To characterize the pharmacokinetics of triamcinolone acetonide (TA) in aqueous, vitreous, and systemic circulation after a single subtenon injection. DESIGN Prospective interventional case series. PARTICIPANTS Thirty-six patients (36 eyes) who received a single posterior subtenon injection of TA (40 mg in 0.4 ml). METHODS Aqueous, vitreous, and blood samples were obtained at 1-hour, 1-day, 3-day, 5-day, 10-day, 14-day, 21-day, and 28-day time points after the posterior subtenon TA injection. At each time point, there were 3 to 6 eyes (patients). The concentrations of TA in the aqueous, vitreous, and plasma were analyzed using ultra-performance liquid chromatography coupled with tandem mass spectrometry. MAIN OUTCOME MEASURES Triamcinolone acetonide concentration in the samples was measured, and pharmacokinetic parameters were calculated. RESULTS The TA concentration-time profile in aqueous consisted of a fast distribution phase during the first 24 hours and a slow elimination phase thereafter. In contrast, the TA concentration-time profile in vitreous consisted of an absorption phase during the first 24 hours followed by a slow elimination phase. The TA in plasma followed a mono-exponential elimination during the study course. The TA concentration peak time for aqueous and plasma was at 1 hour and 24 hours, for vitreous after subtenon injection. The terminal elimination half-life in aqueous, vitreous, and plasma was 11.8, 17.1, and 25 days, respectively. The integral of the area under the concentration time curve (AUC(0-∞)) was 862 ng/day/ml for aqueous, 1262 ng/day/ml for vitreous, and 17.4 ng/day/ml for plasma. The total TA exposure to vitreous was 46% more than total TA exposure to the aqueous. The TA concentration in vitreous was 70- to 98-fold higher than that in plasma. CONCLUSIONS Posterior subtenon TA application can provide a sustained high local ocular TA level while also resulting in a very low systemic TA level, which may be well below the normal glucocorticoid level in humans.
Collapse
Affiliation(s)
- Lijun Shen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, Zhejiang, China
| | | | | | | | | | | |
Collapse
|
12
|
Kim SJ, Flach AJ, Jampol LM. Nonsteroidal anti-inflammatory drugs in ophthalmology. Surv Ophthalmol 2010; 55:108-33. [PMID: 20159228 DOI: 10.1016/j.survophthal.2009.07.005] [Citation(s) in RCA: 240] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 07/20/2009] [Accepted: 07/28/2009] [Indexed: 02/02/2023]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are increasingly employed in ophthalmology to reduce miosis and inflammation, manage scleritis, and prevent and treat cystoid macular edema associated with cataract surgery. In addition, they may decrease postoperative pain and photophobia associated with refractive surgery and may reduce the itching associated with allergic conjunctivitis. In recent years, the U.S. Food and Drug Administration has approved new topical NSAIDs, and previously approved NSAIDs have been reformulated. These additions and changes result in different pharmacokinetics and dosing intervals, which may offer therapeutic advantages. For example, therapeutic effects on diabetic retinopathy and age-related macular degeneration may now be achievable. We provide an updated review on NSAIDs and a summary of their current uses in ophthalmology with attention to potential future applications.
Collapse
Affiliation(s)
- Stephen J Kim
- Department of Ophthalmology, Vanderbilt University, Nashville, Tennessee 37232, USA.
| | | | | |
Collapse
|
13
|
Kim SJ, Martin DF, Hubbard GB, Srivastava SK, Yan J, Bergstrom CS, Aaberg TM. Incidence of Postvitrectomy Macular Edema Using Optical Coherence Tomography. Ophthalmology 2009; 116:1531-7. [DOI: 10.1016/j.ophtha.2009.02.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 02/04/2009] [Accepted: 02/04/2009] [Indexed: 02/02/2023] Open
|
14
|
Abstract
BACKGROUND We set up this retrospective study to examine how different the functional and morphological results are following pars plana vitrectomy (ppV) for idiopathic macular holes in phakic eyes with later cataract surgery and in pseudophakic eyes, and to what extent cataract surgery can induce reopening of idiopathic macular holes after ppV. METHODS A total of 189 eyes were vitrectomized because of idiopathic macular hole (37 pseudophakic, 152 phakic); 120 (22 pseudophakic, 98 phakic) of these eyes were examined at follow-up of an average of 19 months after vitrectomy. Cataract surgery was performed in 65 of the phakic eyes in this period. The functional and morphological results recorded for these 22 pseudophakic and 65 phakic eyes were evaluated. RESULTS In the pseudophakic eyes preoperative visual acuity was 0.14, increasing to 0.20 postoperatively (p=0.16); in 1 case (4.5%) the macular hole was not closed at the time of the follow-up examination. Cataract extraction was performed in 65 of the phakic eyes an average of 10 months after ppV. The initial VA was 0.19 before ppV and increased to 0.37 (p<0.01) after cataract surgery; in 4 cases (6.2%) the macular hole was not closed by the time of the follow-up examination, but in each case this had already been noted when the cataract extraction was done. Reopening did not occur after cataract extraction in any of these cases. CONCLUSION With a rate of 5.7% for reopening or persistence of macular holes, our results are comparable to those recorded in other studies. Cataract surgery following ppV does not influence the reopening rate of macular holes.
Collapse
Affiliation(s)
- A Hager
- Augenabteilung, Asklepios Klinik Nord - Heidberg, 22415, Hamburg.
| | | | | |
Collapse
|
15
|
Scholl HPN, Fleckenstein M, Krohne TU, Holz FG. Klassifikation biomedizinischer Forschungsberichte als Grundlage evidenzbasierter Medizin in der Augenheilkunde. Ophthalmologe 2005; 102:1152-61. [PMID: 16283184 DOI: 10.1007/s00347-005-1293-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Evidence-based medicine requires careful appraisal of published data derived from experimental and clinical studies. Based on classification of biomedical research reports, evidence levels can be determined and recommendations for therapeutic decisions can be made. METHODS A classification system for clinical studies was developed. It was evaluated in classifying the reports published in Der Ophthalmologe during 2003-2004 (study design: descriptive cross-sectional study, case series). RESULTS In the 2-year interval, 70 longitudinal and 95 cross-sectional studies were published. The vast majority of the longitudinal studies were interventional cohort studies. Not considering case reports, 73% of the original articles were longitudinal prospective studies, 1% were retrospective (case-control) studies, and 26% were cross-sectional studies. CONCLUSIONS The study design of all published articles could be classified using the classification system. This classification system proves to be applicable in the context of clinical studies in ophthalmology and may be helpful in the process of critical appraisal of the literature and synthesis of clinical evidence and an evidence-based recommendation.
Collapse
|
16
|
Hager A, Ehrich S, Wiegand W. Anatomische und funktionelle Ergebnisse nach elektiver Makulachirurgie. Ophthalmologe 2005; 102:597-602. [PMID: 15830201 DOI: 10.1007/s00347-004-1095-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this paper is to assess the anatomical and functional results after macular surgery in a large group of patients. METHODS Between June 1995 and December 2001, 381 eyes underwent vitreous surgery for macular pucker (n=244) or macular holes (n=137) with a standard pars plana vitrectomy (PPV) with induction of posterior vitreous separation, membrane peeling, peeling of the internal limiting membrane (no ICG staining was used), and gas instillation (SF(6)). RESULTS A second surgical intervention due to vision-threatening complications after PPV had to be performed in 8 of 381=2.1%. In the macular pucker group, metamorphopsias improved in 46.6% and the median of visual acuity (VA) improved from preoperative 0.3 to postoperative 0.5. Hole closure of macular holes was obtained in 92.2%; the median of VA improved in this group from preoperative 0.2 to postoperative 0.4. CONCLUSION In our group a second vitreoretinal procedure due to vision-threatening complications had to be performed in 2.1%. Compared to the spontaneous course, PPV for macular pucker or macular hole has a very positive influence on functional parameters.
Collapse
Affiliation(s)
- A Hager
- Augenabteilung, Klinikum Nord-Heidberg, Hamburg.
| | | | | |
Collapse
|
17
|
Abstract
The theory of macular hole pathogenesis, which had so far been based on biomicroscopy, has been considerably altered by optical coherence tomography. The precise presentation of vitreofoveal pathology shows that forces acting in different directions are associated with different stages of the disease, making surgical treatment adapted to the different stages possible. Some surgical procedures are still controversial, and there is still no gold standard in macular hole surgery. Especially no agreement exists on the benefit of internal limiting membrane peeling, possibly assisted by staining with indocyanine green. Also details of endotamponade and postoperative positioning are controversial. Therefore, the method of surgical treatment depends a lot on the individual surgeon. This review summarizes the broad spectrum of the literature and the present knowledge in this field.
Collapse
Affiliation(s)
- S Dithmar
- Universitätsaugenklinik, Heidelberg.
| |
Collapse
|