Ocular Pulse Amplitude and Retinal Vessel Caliber Changes after Intravitreal Dexamethasone Implant

Purpose:

The purpose of this study is to evaluate possible changes in ocular pulse amplitude (OPA), retinal arteriole caliber (RAC), and retinal venule caliber (RVC), following the intravitreal injection of dexamethasone implants (DIs).

Methods:

Thirty-four eyes of 34 patients with macular edema were included. All participants received a full ophthalmologic examination at baseline. RAC and RVC were measured via optical coherence tomography; OPA and intraocular pressure (IOP) were measured via dynamic contour tonometry at baseline, month 1, and month 3. Statistical analysis was performed for before-after comparison of OPA, IOP, RAC, and RVC measurements.

Results:

The mean OPA (in order to baseline, month 1, month 3) was 2.8 ± 0.8, 2.9 ± 1.0, 2.9 ± 0.9. The mean IOP was 16.8 ± 2.9, 17.3 ± 2.7, 18.4 ± 2.9 mmHg. The mean RAC was 97.8 ± 9.2, 97.2 ± 9.0, 97.6 ± 9.4. The mean RVC was 124.4 ± 8.2, 124.8 ± 8.8, 123.8 ± 8.2. There were no statistically significant changes in RAC (P = 0.688), RVC (P = 0.714), OPA (P = 0.348), and IOP (P = 0.115). There was also no correlation between RAC and OPA (r = 0.12, P = 0.62) or RVC and OPA (r = 0.16, P = 0.68) at the last visit.

Conclusion:

The intravitreal injection of DI does not significantly affect RAC, RVC, or OPA, which indicates that the treatment does not alter overall retinal-choroidal vasculature or hemodynamics.

Changes in pupil size following panretinal retinal photocoagulation: conventional laser vs pattern scan laser (PASCAL)

PurposeTo evaluate and compare the possible changes in pupil size subsequent to panretinal laser photocoagulation (PRP) via conventional laser and pattern scan laser (PASCAL).Patients and methodsForty eyes of 40 patients with diabetic retinopathy were included. 20 eyes had a PRP via conventional laser and formed Group 1. 20 eyes had a PRP via PASCAL laser and formed Group 2. The participants underwent standard ophthalmologic examination at baseline. Automated infrared pupillometry were performed at baseline and month 1.ResultsThe mean pupillary measurements (mm) for Group 1 (in the order photopic, mesopic, and scotopic conditions) were 2.88±0.34, 3.38±0.40, and 3.95±0.38, and changed to 3.64±0.42, 4.18±0.42, and 4.58±0.48, respectively. There was significant increase in pupil size at month 1 (P<0.001, P<0.001, and P<0.00, respectively). For Group 2, they were 2.90±0.38, 3.43±0.36, and 3.90±0.40, and changed to 3.18±0.42, 3.74±0.36, and 4.10±0.38, respectively. There was significant increase in pupil size at month 1 (P=0.018, P=0.014, and P=0.014, respectively). The pupil size increased significantly in both groups in all illumination conditions.ConclusıonWe have demonstrated via automated infrared pupillary measurements that PRP may significantly increase pupil size whether it is performed with conventional laser or PASCAL laser.

Intravitreal ranibizumab in the treatment of choroidal neovascularization secondary to morning glory syndrome in a child

Congenital optic nerve abnormalities may rarely cause choroidal neovascularization (CNV). This case report summarizes the clinical and therapeutic outcomes of a 7-year-old boy with unilateral CNV secondary to morning glory syndrome associated with acute visual acuity loss. The patient was successfully treated with a single intravitreal ranibizumab injection. One month after the injection the visual acuity increased and optic coherence tomography (OCT) showed a decrease in the intraretinal fluid around the CNV. The patient was then called for monthly follow-up visits. No further treatment was needed for the next 12 months after the first treatment. There was no complication related to the injection.

Anti-Vascular Endothelial Growth Factor Treatment for Proliferative Macular Telangiectasia Type 2

Idiopathic macular telangiectasia type 2 (IMT 2), is the most common type of a heterogeneous group of disorders, characterized by telangiectatic alterations of the juxtafoveolar capillary network. Vision loss is due to retinal atrophy and subretinal neovascularization (SRN). Here, we report the outcomes of intravitreal anti-vascular endothelial growth factor injections, bevacizumab or ranibizumab, in four cases with proliferative IMT 2. Baseline best corrected visual acuity (VA) ranged from 20/50 to 20/100. Follow-up time ranged from 12 months to 24 months. One of four patients received one injection, two patients received three injections, and one patient received seven injections. VA improved in three eyes (≥1 line improvement) and decreased in one eye (≥1 line decrease) over time. Final acuity ranged from 20/30 to 20/100. There were no cases of leakage after the cessation of treatment. SRN, which is a complication of IMT 2, should be recognized and treated accordingly.

The time of resolution and the rate of recurrence in acute central serous chorioretinopathy following spontaneous resolution and low-fluence photodynamic therapy: a case-control study

PurposeTo evaluate the resolution time and the recurrence rate of acute central serous chorioretinopathy (CSC) after spontaneous resolution and low-fluence photodynamic therapy (PDT).MethodsCase-control study: The CSC patients who were admitted to our clinic for the first time were included. No treatment was given during the first 6 months. Patients were treated with PDT after 6 months from the initial signs of the disease, if they did not show any sign of resolution. The patients who showed a significant decrease in subretinal fluid after month 6 were not scheduled for PDT. The primary outcomes were the resolution time and the recurrence rate after the first episode. Secondary outcome measures were the change in BCVA and CRT during the follow up.ResultsA total of 77 consecutive eyes of 77 patients were included, 41 eyes (53.2%) with spontaneously resolved CSC and 36 eyes (46.8%) with PDT-treated CSC. The initial resolution time was 4.1±3.2 months in spontaneous resolution group, and 8.1±0.8 months in PDT group, respectively (P<0.001). The recurrence rate was 51.2% in spontaneous resolution group, and 25% in PDT group (P=0.01). The change in BCVA from baseline to the last follow-up visit was statistically significant in both groups (P=0.002, P=0.003, respectively). The change in CRT from baseline to the last follow up was also statistically significant in both groups (P=0.002, P=0.003, respectively).ConclusionsThe recurrence rate of acute CSC was lower in PDT-treated patients than the spontaneously resolved patients.

The role of indocyanine green angiography imaging in further differential diagnosis of patients with nAMD who are morphologically poor responders to ranibizumab in a real-life setting

PurposeTo evaluate the neovascular age-related macular degeneration (nAMD) in patients who were morphologically poor responders to intravitreal ranibizumab (IVR) treatment using indocyanine green angiography (ICGA) for further investigation.MethodsThis was a cross-sectional, retrospective study. The patients with an initial diagnosis of nAMD who made through the clinical examination, optical coherence tomography, and fluorescein angiography imaging, and were treated with at least three monthly IVR injections that resulted with a morphological poor response, were included. ICGA was obtained from the patients and evaluated in regard to differential diagnosis of other macular diseases, which might mimic nAMD.ResultsThe study included 132 eyes of 117 patients. The mean age was 67.4±9.4 years. After ICGA imaging, 13 eyes (9.8%) were diagnosed as true nAMD, 74 eyes (56.1%) as polypoidal choroidal vasculopathy (PCV), 35 eyes (26.5%) as chronic central serous chorioretinopathy (CSC), 3 eyes (2.3%) as retinal angiomatous proliferation (RAP), 3 eyes (2.3%) as choroidal neovascularization secondary to CSC, 2 eyes (1.5%) as adult-onset vitelliform macular dystrophy, and 2 eyes (1.5%) as drusenoid pigment epithelial detachment with vitelliform material, respectively. The duration between the initial diagnosis and the revised diagnosis was 15.6±10.5 months in the non-AMD group, and the mean injection number of these patients was 6.6±4.4.ConclusionsMost of the nAMD patients who were thought to be morphologically poor responders to IVR were diagnosed as having non-AMD diseases via ICGA. A detailed differential diagnostic work-up is needed before considering these patients as poor responders.

Changes in Pupil Size Following Panretinal and Focal/Grid Retinal Photocoagulation: Automatic Infrared Pupillometry Study

PURPOSE

To evaluate possible changes in pupil size subsequent to panretinal and focal/grid laser photocoagulation.

METHODS

Sixty-four eyes of 64 participants were included. Thirty-two eyes with planned panretinal photocoagulation formed Group 1, and 32 eyes with planned focal retinal photocoagulation formed Group 2. The participants underwent full ophthalmologic examination at baseline. Automated infrared pupillometry was performed at baseline and month 1.

RESULTS

The mean pupillary measurements (in millimeters) for Group 1 (in order photopic, mesopic, scotopic) were 3.09 ± 0.69 mm, 3.66 ± 0.85 mm, and 3.87 ± 1.01 mm and changed to 3.34 ± 0.74 mm, 3.82 ± 0.92 mm, and 4.03 ± 1.02 mm. There was a significant increase in pupil size at month 1 (P = 0.001, P = 0.001, P = 0.003). For Group 2, they were 2.65 ± 0.87 mm, 3.08 ± 1.08 mm, and 3.18 ± 1.19 mm and changed to 2.92 ± 0.72 mm, 3.45 ± 0.76 mm, and 3.57 ± 0.88 mm. There was no significant difference in pupil size at month 1 (P = 0.151, P = 0.106, P = 0.095).

CONCLUSION

We have demonstrated through automated infrared pupillary measurements that panretinal laser photocoagulation may significantly influence pupil size and focal/grid laser photocoagulation may not.

Comparison of intravitreal ranibizumab between phakic and pseudophakic neovascular age-related macular degeneration patients: Two-year results

Background and objective

To compare the efficacy of intravitreal ranibizumab (IVR) for the treatment of neovascular age-related macular degeneration (nAMD) between phakic and pseudophakic eyes after a follow-up of two years.

Materials and methods

Data were analyzed retrospectively. The newly diagnosed and treatment naïve nAMD patients were included in the study. The patients were divided into two subgroups: phakic group, and pseudophakic. All patients received 3 consecutive monthly IVR injections, and then the treatment was continued on an as-needed regimen. Patients were examined monthly, and the data at the baseline, at month 6, 12, 18, and 24 were evaluated. The changes in best corrected visual acuity (BCVA), central retinal thickness (CRT), and the number of injections were compared between the two groups.

Results

The study included 92 eyes of 87 patients (58 phakic, 34 pseudophakic). Mean logarithm of the minimal angle of resolution (LogMAR) VA at the baseline, and at month 6, 12, 18, and 24 was 0.89, 0.74, 0.75, 0.73, and 0.75, in the phakic group; and 0.79, 0.71, 0.66, 0.70, and 0.70 in the pseudophakic group, respectively. The change in mean BCVA from the baseline to month 6, 12, 18, and 24 was not statistically different between the two groups (p = 0.4, p = 0.9, p = 0.5, p = 0.6, respectively). Mean injection number at month 24 was 7.9 and 8.1 in the phakic and pseudophakic group, respectively (p = 0.7).

Conclusion

Intravitreal ranibizumab treatment on an as-needed treatment regimen is effective in preserving vision and improving central retinal thickness in both the phakic and pseudophakic group of nAMD patients. The functional and anatomical outcomes of the treatment, and the number of injections were similar in the phakic and pseudophakic nAMD patients after a follow-up time of 24 months.

Steroid-induced central serous chorioretinopathy in a patient with non-arteritic anterior ischemic optic neuropathy

Non-arteritic anterior ischemic optic neuropathy is a result of an infarction of the small vessel at the anterior portion of the optic disc and causes acute, unilateral, painless visual loss. There is no generally accepted treatment method for this condition but some medical and surgical treatments are recommended. Earlier studies show that visual acuity recovery was better with corticosteroid medication compared to non-treated patients. However corticosteroids may cause side effects such as cataract, increased intraocular pressure and rarely central serous chorioretinopathy. This case report presents a patient with central serous chorioretinopathy secondary to corticosteroid medication.

Choroidal thickness of children's eyes with anisometropic and strabismic amblyopia

PURPOSE

To compare the choroidal thickness of children's eyes with amblyopia due to strabismus or anisometropia to the fellow eye and age-matched controls.

METHODS

Forty patients with anisometropic amblyopia, 40 patients with strabismic amblyopia, and 40 age-matched controls were included in this cross-sectional study. Choroidal thickness was measured via the enhanced-depth imaging technique of spectral domain optical coherence tomography in all patients and controls. Choroidal thickness was measured at subfoveal area and at 500 μm intervals to the nasal and temporal to the fovea up to 2000 μm. Measurements were compared between the three groups.

RESULTS

The mean ages were 7.9 ± 2.6 years (range, 4-13 years) in the anisometropic group, 9.0 ± 3.7 (range 4-15 years) years in the strabismic group, and 8.4 ± 2.6 years (range 4-15 years) in the control group. The mean subfoveal choroidal thickness in the anisometropic group was 362 ± 82 μm in the amblyopic eyes and 301 ± 54 μm in the fellow eyes; in the strabismic group, 413 ± 82 μm in the amblyopic eyes and 316 ± 54 μm in the fellow eyes. The mean subfoveal choroidal thickness was 310 ± 78 μm in control eyes. The subfoveal choroids of both anisometropic and strabismic amblyopic eyes were significantly thicker than that of the fellow eyes of the corresponding groups and the control eyes (P < 0.05 for all).

CONCLUSIONS

The subfoveal choroid of eyes with anisometropic and strabismic amblyopia is significantly thicker than that of the fellow eye and the age-matched controls.

Comparison of intravitreal bevacizumab treatment between phakic and pseudophakic neovascular age-related macular degeneration

INTRODUCTION

Before the era of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment, only prevention for visual loss might have been achieved in a limited number of neovascular age-related macular generation (nAMD) patients with different treatment options.

OBJECTIVE

To compare the efficacy of intravitreal bevacizumab (IVB) for the treatment of nAMD between phakic and pseudophakic eyes.

MATERIALS AND METHODS

The newly diagnosed nAMD patients were included in this retrospective study. The patients were divided into the phakic and pseudophakic groups. Initially, the patients received three consecutive, monthly, IVB injections, and then the treatment was continued on an as-needed regimen. The patients were examined monthly, and the data at the baseline, at 3, 6, 9, and 12 months and at the last follow-up were evaluated. The changes in the visual acuity (VA), central retinal thickness (CRT) and the number of injections were compared between the two groups.

RESULTS

The study included 62 eyes of 62 patients (39 phakic, and 23 pseudophakic patients). The mean follow-up time was 19.7 and 17.2 months in the phakic and pseudophakic groups, respectively (p=0.06). The mean Log MAR VA at the baseline, 12 months and the last follow-up was 0.82, 0.72 and 0.75 in the phakic group and 0.77, 0.67, and 0.68 in the pseudophakic group, respectively. The change in the mean BCVA from the baseline to 12 months and at the last follow-up was not statistically different between the two groups (p=0.9 and p=0.7, respectively). The mean injection number at 12 months was 4.5 and 4.9 in the phakic and pseudophakic group, respectively (p=0.2).

CONCLUSION

The beneficial effect of IVB is equal in both the phakic and pseudophakic group of nAMD patients. The functional and anatomical outcomes of the treatment and the number of injections were similar in the two groups.

Comparison of the Plusoptix A09 and Retinomax K-Plus 3 with retinoscopy in children

PURPOSE

To compare refractive measurements between the Plusoptix A09 (Plusoptix GmbH, Nuremberg, Germany), Retinomax K-Plus 3 (Right Med, Virginia Beach, VA), and retinoscopy in pediatric patients.

METHODS

Two hundred eyes of 200 patients (94 female, 106 male) were included in this cross-sectional study. Non-cycloplegic refraction was measured via the Plusoptix A09 and cycloplegic refraction was measured via the Retinomax K-Plus 3 and retinoscopy. Each device was evaluated for repeatability. The average measurements from all devices were compared.

RESULTS

The mean age of the patients was 6.2 ± 2.8 years (range: 4 to 12 years). The mean non-cycloplegic refraction via Plusoptix A09 was 0.74 ± 1.85 diopters (D) spherical and -0.79 ± 0.78 D cylindrical. The mean cycloplegic refraction via the Retinomax K-Plus 3 was 0.13 ± 1.92 D spherical and -0.74 ± 0.69 D cylindrical. The mean cyloplegic retinoscopy measurement was 0.71 ± 1.81 D spherical and -0.70 ± 0.76 D cylindrical. There was no significant difference between measurements (P = .07).

CONCLUSIONS

The Plusoptix A09 and Retinomax K-Plus 3 agree well with cycloplegic retinoscopy. Both devices may be used for screening children between 4 and 12 years old. The Plusoptix A09 may eliminate the need for cycloplegia for the detection of refractive errors in children.

Intravitreal bevacizumab for choroidal neovascularization secondary to angioid streaks: A report of two patients

The aim of this study is to report clinical course of choroidal neovascularization secondary to angioid streaks (AS) in two patients who underwent intravitreal bevacizumab therapy. Fundus examination, fluorescein angiography (FA) and optical coherence tomography (OCT) revealed the diagnosis of subfoveal classic choroidal neovascularization (CNV) in the right eye in patient 1 and in the left eye in patient 2. After three consecutive bevacizumab injections, visual acuity improved from 20/40 to 20/25 in patient 1 and from 20/80 to 20/50 in patient 2. After 3 months of therapy, additional bevacizumab injection was administered when the lesion showed recurrence. After a follow-up time of 24-months, patient 1 received 14 intravitreal bevacizumab injections; patient 2 received only 4 injections. Visual acuities remained stable at 20/32 and 20/50 in patient 1 and patient 2, respectively. Though, the patients of CNV secondary to AS showed similar clinical appearance at the beginning, this report provides the data for different responses to intravitreal bevacizumab therapy. While fewer injections were required to control the disease in one patient, the other patient needed much more injections for stabilization of the CNV. Further studies are required to understand the cause of varied treatment responses in those patients.

Can perifoveal pseudocyst area be a prognostic factor in macular hole surgery?: A prospective study with quantitative data

To evaluate the effect of perifoveal pseudocysts on the anatomical outcomes of the idiopathic macular hole surgery as a prognostic factor. Twenty-one eyes of 20 consecutive patients with a Gass stage 3 or 4 idiopathic macular hole were enrolled in this prospective study between March 2012 and May 2013. Demographic data, medical history, and ocular examinations were recorded preoperatively and on postoperative day 1, week 1, and month 1, 3, and 6. Five spectral domain optical coherence tomography (SD-OCT) parameters were analyzed: macular hole (MH) basal diameter, MH minimum diameter, MH height, macular hole index, and a new parameter, the area of macular pseudocysts via the software of SD-OCT device at the widest cross section of the MH formation. The mean preoperative best-corrected visual acuity was 0.86±0.29 logarithm of the minimum angle of resolution (LogMAR) (between 0.4 and 1.3) and improved to 0.64±0.28 LogMAR (between 0.22 and 1.23) postoperatively (P=0.004). There was a statistical significant difference between both MH basal diameter and MH pseudocyst area with anatomical success, respectively (P=0.016 for MH basal diameter, P=0.004 for MH pseudocyst area). The anatomical closure was correlated with MH basal diameter and MH pseudocyst area (P=0.01 and P=0.001, respectively). Spearman correlation rank coefficient between with MH basal diameter and MH pseudocyst area was r=0.493 and statistically significant (P=0.02). Perifoveal pseudocysts seem to be associated with anatomic failure and may be used as a prognostic factor in MH surgery.

Intravitreal ranibizumab for bilateral choroidal neovascularisation in a patient with angioid streaks

Angioid streaks are described as irregular lines deep into the retina, configured in a radiating fashion which results from breaks in Bruch's membrane. Optic nerve head drusen are acellular, globular deposits located within the optic nerve head. Angioid streaks and optic nerve head drusen may coexist in patients with pseudoxanthoma elasticum. Both disorders may cause choroidal neovascularisation. In this case report we aimed to present a 48-year-old man with pseudoxanthoma elasticum. The patient had bilateral choroidal neovascularisation secondary to angioid streaks and was treated with intravitreal ranibizumab injections. Visual acuity was increased and maintained at the same level during the follow-up time. There was no complication related to the injection.

A single injection of intravitreal ranibizumab in the treatment of choroidal neovascularisation secondary to optic nerve head drusen in a child

Optic nerve head drusen are acellular, calcified deposits which may be found in buried or exposed drusen form. Choroidal neovascularisation secondary to optic nerve head drusen is rarely seen in childhood. This case report summarises the clinical and therapeutic outcomes of a 13-year-old girl with unilateral choroidal neovascularisation secondary to optic nerve head drusen. The patient was successfully treated with a single intravitreal ranibizumab injection. After a month from the injection the visual acuity increased dramatically and maintained at the same level during 9 months of follow-up time. There was no complication related to the injection.

Comparison of efficacy between low-fluence and half-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy

Purpose

To compare the efficacy of low-fluence photodynamic therapy (PDT) and PDT with half-dose verteporfin in chronic central serous chorioretinopathy (CSC).

Patients and methods

The medical records of 64 eyes from 60 patients with chronic CSC were retrospectively reviewed; 36 eyes received low-fluence PDT (25 J/cm²) and 28 eyes received half-dose verteporfin PDT (3 mg/m²). The primary outcome measure was the proportion of eyes with complete resolution of subretinal fluid. Secondary outcome measures were the changes in best corrected visual acuity (BCVA) and central foveal thickness, and the proportion of eyes that showed an increase of ≥5 letters in BCVA at the last visit.

Results

The mean follow-up period was 12.5±4.3 months and 13.1±4 months in the low-fluence group and half-dose group, respectively (P=0.568). Thirty-three eyes (91.6%) in the low-fluence group and 26 eyes (92.8%) in the half-dose verteporfin group showed complete resolution of subretinal fluid (P=0.703). BCVA increased by a mean of 7.4 letters and 4.8 letters in the low-fluence group and half-dose group, respectively (P=0.336). Seventeen eyes (52.8%) in the low-fluence group and 14 eyes (50%) in the half-dose group experienced a gain of ≥5 letters in BCVA (P=0.825). In the low-fluence and half-dose verteporfin group, the mean baseline central foveal thickness was 351±90 μm and 341±96 μm, and significantly decreased to 188±61 μm and 181±47 μm, respectively (P<0.01).

Conclusion

Both treatments resulted in complete subretinal fluid resolution in most of the eyes, with significantly better visual acuity outcomes compared to baseline at the last visit.

Long term result of intravitreal bevacizumab in a patient newly transformed to proliferative macular telangiectasia type 2

The clinical and imaging findings and therapeutic outcomes of intravitreal bevacizumab injection in a patient with macular telangiectasia type 2 are described. The patient first presented with the non-proliferative stage of the disease for 4 months, then the disease transformed to the proliferative stage. In the proliferative period, the patient was treated with intravitreal bevacizumab injections as-clinically warranted. Over a follow up period lasting 26 months, the patient received 6 intravitreal bevacizumab injections, the visual acuity improved from 20/100 to 20/40, the central retinal thickness decreased from 318 microns to 198 microns. This case implies that the patients with non-proliferative macular telangiectasia type 2 should be followed carefully for proliferative transformation, and intravitreal bevacizumab treatment seems to be effective for proliferative macular telangiectasia type 2.

Focal laser photocoagulation in non-center involved diabetic macular edema

This study was performed to evaluate the functional and anatomic outcomes of focal macular laser photocoagulation in eyes with non-center involved macular edema (non-CI ME). Forty-nine eyes of 43 patients with non-CI ME were included. Focal macular laser photocoagulation was conducted on twenty-nine eyes of 25 patients, while 20 eyes of 18 patients with non-CI ME were followed without treatment and served as the control group. Data relating to best corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study) and central subfield thickness (CST), inner zone thickness (IZT), outer zone thickness (OZT), and total macular volume (TMV) as determined by optical coherence tomography (OCT) were collected and compared between the groups. At 12 months, VA decreased by a mean of 0.4 letters in the treatment group and 3.3 letters in the control group (p=0.03). Gain in VA ≥5 letters was noted in 6 (21%) of the eyes in the treatment group versus 1 (5%) eye in the control group (p=0.12). At 12 months, average IZT decreased by 22.6 microns in the treatment group and increased by 10.9 microns in the control group (p<0.001). The treatment group revealed significant reduction in CST, average OZT, and TMV as compared to the control group at 12 months (all p<0.05).Generally, focal laser photocoagulation may have more favourable visual outcomes in this specific group of diabetic patients than does observation. In addition, focal laser treatment provided better outcomes with improvement in OCT parameters as compared to the control group.

One-year results of treatment with bevacizumab alone or ranibizumab alone for low visual acuity due to neovascular age-related macular degeneration

PURPOSE

To investigate treatment with bevacizumab alone or ranibizumab alone in neovascular age-related macular degeneration (nAMD) patients with low visual acuity.

METHODS

Data were analyzed retrospectively. Inclusion criteria were (1) pretreatment visual acuity of LogMAR 1.3 or worse and (2) treatment duration of at least 12 months. Injections were given monthly for the first 3 months and thereafter as needed. Data collected for each patient included best corrected visual acuity and central retinal thickness measured before treatment, at months 3, 6, 9, and 12 during treatment, and at the last follow-up visit.

RESULTS

In the bevacizumab patients, mean visual acuity was initially 1.70 LogMAR; at months 3, 6, 9, and 12 during treatment it was 1.20, 1.11, 1.14, and 1.10 LogMAR, respectively, and at the last follow-up it was 1.12 LogMAR (P<0.01 for all differences with respect to the initial value). Mean injection number in the first 12 months was 5.3. In the ranibizumab patients, mean visual acuity was initially 1.53 LogMAR; at months 3, 6, 9, and 12 during treatment it was 1.18, 1.17, 1.17, and 1.28 LogMAR, respectively, and at the last follow-up it was 1.21 LogMAR (P<0.01 for all differences with respect to the initial value). Mean injection number in the first 12 months was 4.2.

CONCLUSION

Patients with nAMD and low pretreatment visual acuities can benefit from treatment with bevacizumab or ranibizumab.

Can intravitreal ranibizumab alter retrobulbar circulation in eyes with age-related macular degeneration?

PURPOSE

To determine the effect of a single intravitreal ranibizumab injection on retrobulbar circulation in cases with neovascular age-related macular degeneration (AMD).

METHODS

In this prospective and interventional study, 32 patients with neovascular AMD were enrolled. A single intravitreal ranibizumab dose was in only 1 eye per patient. Peak systolic velocity, end-diastolic velocity, resistive index and pulsatility index values in the common carotid artery, ophthalmic artery, central retinal artery, nasal posterior ciliary artery, and temporal posterior ciliary artery in both injected and uninjected healthy fellow eyes were measured using color Doppler ultrasonography at baseline and 1 week and 1 month after the injection of ranibizumab.

RESULTS

All measurements revealed no statistically significant difference among baseline, first week, and first month after injection measurements for all parameters measured in all arteries in both the injected and uninjected healthy fellow eyes.

CONCLUSION

A single intravitreal injection of ranibizumab does not significantly affect on retrobulbar circulation of either the injected or the uninjected healthy fellow eyes with neovascular AMD.

Topical nepafenac in treatment of acute central serous chorioretinopathy

This study had been performed to investigate the anatomic and functional outcomes of nepafenac 0.1% therapy in acute central serous chorioretinopathy (CSC). The medical records of 30 patients with acute CSC were reviewed for a total of 31 eye charts. Seventeen eye records of 16 patients who were treated with topical nepafenac 0.1% three times daily for four weeks and continued until complete resolution of subretinal fluid were appraised. Fourteen patients with acute CSC (a total of 14 eye records) who did not receive treatment served as the control group also had been recorded. The proportion of eyes with complete resolution of subretinal fluid, serial changes in the mean best corrected visual acuity (BCVA), and the mean central foveal thickness (CFT) at 6 months of therapy were the outcomes measured. Mean age was 42.6±8.2 years in the treatment group and 41.1±7.1 years in the control group (p=0.85). At 6 months, 14 eyes (82.3%) in the treatment group and 6 eyes (42.8%) in the control group revealed a complete resolution in the subretinal fluid (p=0.02). In the treatment group, mean BCVA (LogMAR) significantly improved from 0.19±0.17 at baseline to 0.09±0.12 at 6 months (p=0.01). In the control group, mean BCVA (LogMAR) was 0.13±0.14 at baseline and decreased to 0.1±0.11 at 6 months (p=0.28). In the treatment group, mean CFT was 349±115 µm at baseline and significantly improved to 221±95 µm at 6 months (p<0.01). In the control group, mean CFT declined from 391±138 µm at baseline to 301±125 µm at 6 months (p=0.06). No treatment-related ocular or systemic side effects were observed. In conclusion, nepafenac 0.1% has the potential to treatment acute CSC. Further trials are warranted to study its safety and efficacy for this disease.

Comparing the effects of three different intravitreal injection techniques on vitreous reflux and intraocular pressure

PURPOSE

To compare the effects of straight, oblique, and double-plane tunnel scleral intravitreal injection techniques, on short-term intraocular pressure (IOP) changes, occurrence of vitreous reflux (VR), and/or other complications.

METHODS

A total of 105 patients were included in this prospective study. Patients were assigned randomly to one of the straight injection group (SI; n=35), oblique injection group (OI; n=35), or double-plane tunnel injection group (DPTI; n=35). The occurrence of VR and preinjection and postinjection IOP at 2 and 6 h were compared between groups, and complications were assessed.

RESULTS

The mean patient age was 71.1±6.6 years (range 58 to 86 years; 50 women and 55 men). In the SI, OI, and DPTI groups, VR occurred in 18 (51.4%), 12 (34.3%), and 6 patients (17.1%), respectively. Mean preinjection IOPs were 15.4, 14.8, and 15.6 mmHg, and changed to 17.3, 18.0, and 20.0 mmHg at the second hour, and 15.7, 16.2, and 16.1 mmHg at the sixth hour, respectively. No significant differences among the groups were found in terms of complications such as transient mild uveitis or subconjunctival hemorrhage.

CONCLUSION

Double-plane tunnel injection prevents VR from the injection site and has no additional complications than other techniques.

Long-term results of phacoemulsification combined with primary posterior curvilinear capsulorhexis in adults

Objective:

To evaluate the 2-year outcomes of phacoemulsification combined with primary posterior curvilinear capsulorhexis (PPCC) in adults.

Materials and Methods:

In this retrospective case series, 93 eyes of 91 patients with bilateral age-related cataract who underwent phacoemulsification combined with PPCC were evaluated. The study included cases due to postoperative residual posterior capsule opacification despite careful polishing. Data were evaluated on preoperative and postoperative best corrected visual acuity (CDVA) (Snellen acuity), slit-lamp biomicroscopy and intraocular pressure (IOP) measurement. Perioperative and postoperative complications were also recorded.

Results:

The mean follow-up was 24.9 ±13.5 months (range, 12-53 months). At the last visit, 87.1% of the eyes had CDVA ≥ 20/40 and 58% had ≥ 20/25. Posterior capsular opacification (PCO) occurred in 2 (2.2%) of patients. No serious complications such as retinal detachment and endophthalmitis were observed during follow-up.

Conclusions:

Cataract surgery combined with PPCC is a safe procedure with a low rate of complications over the long term. This procedure reduced the necessity of Nd:YAG laser capsulotomy in adults with postoperative residual posterior capsule opacification despite careful polishing.

Prophylactic selective laser trabeculoplasty in the prevention of intraocular pressure elevation after intravitreal triamcinolone acetonide injection

PURPOSE

To evaluate the prophylactic efficacy of selective laser trabeculoplasty for preventing an increase in intraocular pressure (IOP) after intravitreal triamcinolone acetonide injection.

DESIGN

Prospective, comparative, interventional case series.

METHODS

We studied 31 eyes with a baseline IOP of 21 mm Hg or more of 31 patients for which intravitreal triamcinolone acetonide injection was planned for diabetic macular edema. The patients were divided into 2 groups, a study group and control group. The study group comprised 15 eyes of 15 patients that underwent selective laser trabeculoplasty a mean of 8.3 ± 4.1 days before intravitreal triamcinolone acetonide injection. The control group comprised 16 eyes of 16 patients who underwent only intravitreal triamcinolone acetonide injection. Main outcomes measures were mean IOP and number of patients requiring antiglaucomatous therapy.

RESULTS

Mean baseline IOP was 21.6 ± 0.9 mm Hg in the study group and 21.5 ± 0.8 mm Hg in the control group (P = .98). Mean IOP at 1 day after injection was 17.0 ± 2.0 mm Hg in the study group and 19.5 ± 4.3 mm Hg in the control group (P = .23). Mean IOP at 1 week after injection was 16.9 ± 1.7 mm Hg and 18.4 ± 4.0 mm Hg, respectively (P = .49); mean IOP at 1 month after injection was 16.4 ± 1.5 mm Hg and 20.8 ± 5.6 mm Hg, respectively (P = .003); mean IOP at 3 months after injection was 15.8 ± 2.5 mm Hg and 18.3 ± 5.5 mm Hg, respectively (P = .01); and mean IOP at 6 months after injection was 15.7 ± 1.4 mm Hg and 17.1 ± 1.5 mm Hg, respectively (P = .03). The number of patients requiring antiglaucomatous therapy during follow-up was 0 of 15 eyes in the study group and 8 of 16 eyes in the control group (P = .001).

CONCLUSIONS

The IOP elevation after intravitreal triamcinolone acetonide injection may be prevented by performing selective laser trabeculoplasty before intravitreal triamcinolone acetonide injection, especially in cases with a baseline IOP of 21 mm Hg or more.

Which procedure has more effect on macular thickness: primary posterior continuous capsulorhexis (PPCC) combined with phacoemulsification or Nd:YAG laser capsulotomy?

To compare the effect of Nd:YAG laser capsulotomy and primary posterior continuous capsulorhexis (PPCC) combined with phacoemulsification on macular thickness using optical coherence tomography (OCT) in adults. This prospective comparative interventional study included 32 eyes of 30 patients who underwent Nd:YAG laser capsulotomy and 33 eyes of 33 patients who underwent cataract surgery with PPCC. Detailed ocular examinations, including macular thickness measurements by OCT, were performed in all patients preoperatively and postoperatively on the 1st day, 1st week, and 1st, 3rd and 6th months. No significant differences were found in macular thickness between the two groups in preoperative and postoperative follow-up. No cystoid changes were observed in OCT during the postoperative period in both groups. Nd:YAG laser capsulotomy and PPCC combined with cataract surgery are safe and effective procedures that are not associated with an increase in macular thickness.

Combined 23-gauge transconjunctival sutureless vitrectomy and cataract surgery in cases with cataract and posterior segment diseases

BACKGROUND

Combined cataract surgery and transconjunctival sutureless vitrectomy are a good option in patients with cataract and vitreoretinal diseases.

AIM

To evaluate the effectiveness, outcomes, and complications of combined 23-gauge transconjunctival sutureless vitrectomy and cataract surgery.

SETTINGS AND DESIGN

A retrospective case series was conducted at the Beyoglu Eye Education and Research Hospital.

MATERIALS AND METHODS

In this study, 28 eyes of 28 patients underwent combined 23-gauge transconjunctival sutureless vitrectomy and phacoemulsification and IOL implantation for cataract and various posterior segment diseases. The outcome measures included, visual acuity, intraocular pressure changes, and anatomical success were evaluated.

RESULTS

The mean follow-up was 4.8 months (range, 3-15 months). Mean overall preoperative visual acuity was 20/333, and final acuity was 20/95 (P < 0.001). Mean intraocular pressure (IOP) on the preoperative and first postoperative day was 15.6 ± 7.5 and 13.8 ± 3.3 mmHg, respectively (P > 0.05). Three eyes (10.7%) had postoperative hypotony (<6 mmHg)that all recovered spontaneously within the first postoperative week. Three eyes (10.7%) required laser treatment for iatrogenic retinal tears. Anatomical success was obtained in all cases. No serious complications such as endophthalmitis were observed during the follow-up period.

CONCLUSION

Combined transconjunctival sutureless vitrectomy and phacoemulsification was effective and safe in patients with significant lens opacities and vitreoretinal pathology. Although the anatomic and visual outcomes were satisfactory, the outcomes depended mainly on underlying vitreoretinal pathology.

Macular thickness changes after phacoemulsification combined with primary posterior curvilinear capsulorhexis

PURPOSE

To evaluate the changes in central macular thickness measured with optical coherence tomography (OCT) after cataract surgery combined with primary posterior continuous curvilinear capsulorhexis (PCCC).

METHODS

Forty-six eyes of 40 consecutive patients who had uneventful phacoemulsification and in-the-bag intraocular lens implantation surgery with primary PCCC, taking place between August 2005 and January 2006 in Beyoglu Eye Training and Research Hospital, were enrolled. Patients with a history of previous ocular surgery, eye trauma, uveitis, or glaucoma, or any systemic disease such as diabetes mellitus, were excluded from the study. None of the cases had macular pathology before surgery. OCT was performed in all patients preoperatively and postoperatively on the first day, first week, and first, third, and sixth months.

RESULTS

Significant quantitative changes from the preoperative examination were observed in the postoperative first week, first month, and third month (p<0.05). The difference between the mean preoperative and postoperative sixth month central macular thickness was not statistically significant (p=0.20). The greatest change in mean macular thickness was noted in the first month visit. No patient developed cystoid macular edema.

CONCLUSIONS

Because primary PCCC does not have an adverse effect on macular integrity, this procedure may be preferred especially in patients with a high risk of posterior capsular opacification.

A case of spina bifida with ocular manifestations

Neural tube defects are common congenital abnormalities associated with a variety of complications. Spina bifida, among the most common, results from failure of the neural tube and the vertebral bones to close during embryogenesis. Myelomeningocele is the most common severe form of spina bifida. It may be associated with various anomalies in different tissues. Here we report a case of spina bifida with associated ocular anomalies and review the literature of previous spina bifida cases with ocular manifestations.

The effects of posterior continuous curvilinear capsulorhexis on contrast sensitivity

PURPOSE

We aimed at evaluating the effects of posterior continuous curvilinear capsulorhexis (PCCC) on contrast sensitivity.

MATERIALS AND METHODS

In this prospective, randomized, bilateral clinical study, 40 eyes of 20 patients who underwent bilateral cataract surgery were included. The phacoemulsification machine, viscoelastic substances, surgical tools, and intraocular lenses (IOLs) were the same for both eyes. The only difference was that we conducted the PCCC procedure before IOL implantation to one of the eyes of the patients. The selection of the eye that underwent the PCCC procedure was decided randomly.

RESULTS

The mean photopic contrast sensitivity values at spatial frequencies of 1.5, 3, 6, 12, and 18 cpd (cycles per degree) were 41.55, 59.90, 61.25, 32.35, and 9.75, respectively, and for the control group these values were 39.05, 56.60, 57.95, 29.80, and 8.75, respectively. The mean mesopic contrast sensitivity values at special frequencies of 1.5, 3, 6, 12, and 18 cpd were 41.20, 54.75, 55.55, 31.70, and 9.00, respectively, and for the control group these values were 38.35, 51.70, 52.15, 30.05, and 8.00, respectively. The mean contrast sensitivity values of the eyes that underwent the PCCC procedure were slightly better than the fellow eyes at all spatial frequencies, but the difference was statistically insignificant (P>0.05).

CONCLUSIONS

In early post-operative period, the PCCC procedure exerts some positive effects on contrast sensitivity although these effects are statistically insignificant.

Number of axons in the right and left optic nerves of right-pawed and left-pawed rats: a stereologic study

OBJECTIVE

To compare the number of axons in the right and left optic nerves of right- and left-pawed rats.

STUDY DESIGN

In this study, optic nerve samples were obtained from right- and left-pawed rats and axon numbers of optic nerves and vice versa were stereologically and histologically evaluated.

RESULTS

In the right-pawed rats, more axons were found in the right optic nerve than in the left optic nerve, and left-pawed rats had more axons in the left optic nerve than in the right optic nerve.

CONCLUSION

The paw preference is associated with eye dominance and the number of axons in the ipsilateral optic nerve.

The formation of cataract is earlier in the dominant eye

Relations among handedness, eye dominance, and lateralisation in the formation of cataract were investigated in 35 male and 21 female patients with cataract. In right-handed patients, cataracts formed earlier in the right eyes than in the left eye; this was reversed in left-handed patients. For both right- and left-eye dominant patients, cataracts formed earlier in the dominant eye.

Relation between intraocular pressure and size of transverse sinuses

There are asymmetries in the sizes of transverse sinus and intraocular pressure. The purpose of this study was to investigate possible relationships between the asymmetry of transverse sinuses in TOF MR venography and intraocular pressures of right and left eyes. In this study, subjects were 63 male and 42 female medical school students, aged 18-21 years (mean+/-SD; 19.72+/-0.67 years). Subjects with neurological and ophthalmologic disease, particularly dural sinus thrombosis, myopia, trauma and glaucoma, were excluded the study. Subjects were divided into five groups according to the magnitudes of the right- and left-transverse sinuses in MR venography results. There is a functional relation between intraocular pressures of the right and left eyes and asymmetry of the transverse sinus. If the transverse sinus on one side is larger and its venous drainage is greater, the intraocular pressure of the eye on this side is lower. It can be speculated that the transverse sinus size may be associated with pathogenesis of diseases with increased intraocular pressure such as glaucoma. We aim to determine the relation between the size and drainage of transverse sinuses in TOF MR venography and intraocular pressure in patients with open-angle glaucoma in our next study.

Sex-related difference in intraocular pressure in healthy young subjects

Sex-related differences in intraocular pressures of the right and left eye was studied in 64 men and 61 women, all young and right-handed. Intraocular pressures of the right and left eye were higher for women than men. Sex-related difference in intraocular pressure may be associated with presence of the sex hormone, oestrogen, in women which reduces sympathetic activity.

Correlation between hand preference and intraocular pressure from right- and left-eyes in right- and left-handers

To test whether there is a relationship between handedness and the intraocular pressure and there is a lateralization in the intraocular pressure, the intraocular pressures of the right- and left-eyes were compared in right- and left-handed students. The intraocular pressures were higher in the right-eye than in the left-eye in men, right-handers, and right-eyed subjects; there was no right-left difference in females, left-handers, left-eyed, and both-eyed subjects. The intraocular pressure of right- and left-eyes was higher in left-handers than right-handers. And there were significant negative correlations between hand preference and the intraocular pressure of both right- and left-eyes. We have concluded that the dominant eye has higher intraocular pressure compared to the nondominant one, and there is a relationship between hand preference and the intraocular pressure.