Angiographic Cystoid Macular Edema Research Articles

Angiographic Cystoid Macular Edema and Outcomes in the Comparison of Age-Related Macular Degeneration Treatments Trials

To describe morphologic and visual outcomes in eyes with angiographic cystoid macular edema (CME) treated with ranibizumab or bevacizumab for neovascular age-related macular degeneration (nAMD). Prospective cohort study within a randomized clinical trial. A total of 1185 CATT study subjects. Baseline fluorescein angiography (FA) images of all CATT study eyes were evaluated for CME. Grading of other characteristics on optical coherence tomography (OCT) and photographic images at baseline and during 2-year follow-up was completed by readers at the CATT Reading Centers. Three groups were created on the basis of baseline CME and intraretinal fluid (IRF) status: (1) CME, (2) IRF without CME, (3) neither CME nor IRF. Visual acuity (VA) and total central retinal thickness (CRT) on OCT at baseline, year 1, and year 2. Among 1131 participants with images of sufficient quality for determining CME and IRF at baseline, 92 (8.1%) had CME, 766 (67.7%) had IRF without CME, and 273 (24.1%) had neither. At baseline, eyes with CME had worse mean VA (letters) than eyes with IRF without CME and eyes with neither CME nor IRF (52 vs. 60 vs. 66 letters, P < 0.001); higher mean total CRT (μm) on OCT (514 vs. 472 vs. 404, P < 0.001); and greater hemorrhage, retinal angiomatous proliferation (RAP) lesions, and classic choroidal neovascularization (CNV). All groups showed improvement in VA at follow-up; however, the CME group started and ended with the worst VA among the 3 groups. Central retinal thickness, although higher at baseline for the CME group, was similar at 1 and 2 years follow-up for all groups. More eyes with CME (65.3%) developed scarring during 2 years of follow-up compared with eyes with IRF without CME (43.8%) and eyes with neither CME nor IRF (32.5%; P < 0.001). In CATT, eyes with CME had worse baseline and follow-up VA, although all groups showed similar rates of improvement in VA during 2 years of follow-up. Cystoid macular edema seems to be a marker for poorer visual outcomes in nAMD because of underlying baseline retinal dysfunction and subsequent scarring.

Prospective study of incidence of cystoid macular edema in uneventful cataract surgery: a study of 100 cases

Background: Cystoid macular edema (CME) is the important postoperative complication of cataract surgery, which can compromise the result of a cataract surgery. It can occur even after uneventful cataract surgery, but the incidence rapidly increase after complicated cataract surgery. Fundus fluorescein angiography (FFA) has been used for long time for diagnosis of cystoid macular edema. Angiographic CME, which is the presence of fluorescein leakage within the macular area without visual impairment, must be differentiated from clinical CME. The incidence of the two forms is different, with the angiographic form being much more common. Angiographic CME was reported to occur in 3–70% of the patients 4–6 weeks after cataract surgery. Objective: To study the incidence of cystoid macular edema in uneventful cases of small incision cataract surgery (SICS). Materials and Methods: This prospective study comprised 100 eyes of 100 patients who have undergone SICS with IOL implantation. Incidence of CME was found with the help of FFA. Results: In the study, 40 male patients and 60 female patient who underwent uneventful SICS of whom 20% male were CME positive and 20% female were CME positive. Angiographic CME (20%) incidence was more than clinical CME (2%). The incidence of CME was more on 30th post-operative day as compared to 7th post-operative study. intracameral adrenaline increases the incidence of CME. Conclusion: Incidence of clinical cystoid macular edema is 2% in uncomplicated cataract surgery, incidence of angiographic cystoid macular edema is 20%.

Prophylactic use of ketorolac tromethamine in cataract surgery: a randomized trial.

To determine the efficacy of topical ketorolac tromethamine in preventing cystoid macular edema (CME) after uncomplicated cataract surgery. This single-center, prospective, double-masked, randomized clinical trial consisted of 81 patients who were scheduled for cataract surgery. Patients were randomized to receive hypromellose/dextran 70 as a placebo (n=44) or ketorolac tromethamine 0.4% (n=37) as an adjuvant therapy. These eye drops were administered 4 times daily (QID) for 3 days before surgery and 5 weeks postoperatively. All patients received prednisolone acetate 1% QID during the same period as basal/standard anti-inflammatory therapy. The primary outcome was the incidence of angiographic CME 5 weeks after surgery. The secondary outcomes were mean change in best-corrected visual acuity (BCVA) [Early Treatment Diabetic Retinopathy study (ETDRS)], clinical CME incidence, intraocular pressure, and retinal thickness measured using optical coherence tomography (OCT). In the placebo group, 2/44 (4.5%) patients and in the ketorolac group, 2/37 (5.4%) patients presented with angiographic CME (P=0.624). The mean change in postoperative BCVA was 32±15 letters in the placebo group and 26±16 letters in the ketorolac group (P=0.07). There were no statistically significant between-group differences in the mean central subfield thickness (P=0.679), minimal central thickness (P=0.352), or central macular volume (P=0.729). There was no difference between ketorolac tromethamine and a placebo with regard to BCVA results or prevention of CME after uncomplicated cataract surgery.

Evaluation of Cystoid Macular Edema Using Optical Coherence Tomography and Fundus Fluorescein Angiography after Uncomplicated Phacoemulsification Surgery

Purpose: To evaluate the central macular thickness (CMT) and the cystoid macular edema (CME) after uncomplicated phacoemulsification surgery.Material and methods: Ninety-one eyes of 88 patients who underwent uncomplicated phacoemulsification surgery between December 2008 and May 2009 were included in the study. Detailed ophthalmologic examinations and spectral domain optical coherence tomography (OCT) measurements were done preoperatively and at postoperative 1st, 4th, 12th, and 24th weeks. Best corrected visual acuity (BCVA) was measured as logMAR units at preoperative and all postoperative visits. Mean CMT, and perifoveal macular thickness in superior, inferior, nasal and temporal quadrants were recorded. CME was defined as three standard deviations (SD) above the preoperative mean CMT in OCT measurements. Fundus fluorescein angiography (FFA) was performed at postoperative 12th weeks. Data was analyzed statistically by using ANOVA test, and paired samples t test with Bonferroni correction.Results: The mean preoperative CMT was 255.68 ± 23.04 µm. The increase in CMT was statistically significant at postoperative 1st, 4th, 12th, and 24th weeks (p = 0.043). The most significant increase in CMT was seen at 12th weeks (p = 0.028). The change in perifoveal macular thickness measurements in the temporal, nasal, superior and inferior quadrant was statistically significant at postoperative 12th weeks (p < 0.001, for all measurements). The increase in macular thickness did not correlate with BCVA at postoperative 1st and 4th weeks but there was a significant correlation at postoperative 12th and 24th weeks. The incidence of angiographic CME at postoperative 12th weeks was 3.2%. The appearance of CME in OCT was observed in 5.5% of eyes at postoperative 12th weeks.Conclusion: Macular thickness changes after uncomplicated phacoemulsification surgery and Spectral domain OCT is helpful in detecting cystoid abnormalities and any increase in macular thickness at postoperative early periods. Changes seen on OCT do not completely correlate with FFA findings.

Nepafenac 0.1% versus fluorometholone 0.1% for preventing cystoid macular edema after cataract surgery

To compare a topical nonsteroidal antiinflammatory drug (nepafenac 0.1%) and a topical steroidal antiinflammatory drug (fluorometholone 0.1% ) in preventing cystoid macular edema (CME) and blood-aqueous barrier (BAB) disruption after small-incision cataract extraction with foldable intraocular lens (IOL) implantation. Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, Japan. Randomized double-masked single-center clinical trial. Patients were randomized to receive nepafenac 0.1% eyedrops or fluorometholone 0.1% eyedrops for 5 weeks after phacoemulsification with foldable IOL implantation. The incidence and severity of CME were evaluated by fluorescein angiography, retinal foveal thickness on optical coherence tomography, and BAB disruption on laser flare-cell photometry. Thirty patients received nepafenac and 29 patients, fluorometholone. Five weeks postoperatively, the incidence of fluorescein angiographic CME was significantly lower in the nepafenac group (14.3%) than in the fluorometholone group (81.5%) (P<.0001). The fovea was thinner in the nepafenac group than in the fluorometholone group at 2 weeks (P=.0266) and 5 weeks (P=.0055). At 1, 2, and 5 weeks, anterior chamber flare was significantly less in the nepafenac group than in the fluorometholone group (P<.0001, P<.0001, and P=.0304, respectively). The visual acuity recovery from baseline was significantly greater in the nepafenac group (80.0%) than in the fluorometholone group (55.2%) (P=.0395). There were no serious side effects in either group. Nepafenac was more effective than fluorometholone in preventing angiographic CME and BAB disruption, and results indicate nepafenac leads to more rapid visual recovery.

Treatment of postoperative macular edema

Abstract Purpose Cystoid macular edema (CME) is a frequent complication of a number of interventions in ophthalmology, such as cataract surgery (Irvine‐Gass syndrome), laser procedures, and trabeculectomy. The purpose of this talk is to present the latest bibliographic data regarding the appropriate treatment of postoperative CME. Methods A review of the existing literature concerning the treatment of postoperative CME is performed. Characteristic personal cases are presented. Results In more than two‐thirds of the cases, postoperative CME resolves spontaneously within weeks or months. Prophylactic topical treatment with indomethacin or flurbiprofen seems to reduce the frequency of clinical and angiographic CME, but its beneficial effect on final visual acuity is not established. Curative therapy includes topical corticosteroids; topical non‐steroidal anti‐inflammatory drugs (e.g. ketorolac); oral acetazolamide; sub‐Tenon or intravitreal injection of triamcinolone acetonide; intravitreal injection of anti‐VEGF drugs; and pars plana vitrectomy. The indications, role, and efficacy of each of the above treatment modalities are discussed, based on the latest bibliographic data. Conclusion Most cases of postoperative CME are mild and resolve spontaneously. In refractory cases, sub‐Tenon or intravitreal injection of triamcinolone acetonide can be effective, but the risk of ocular hypertony is high. Intravitreal injection of anti‐VEGF drugs offers promising results, yet large‐scale randomized studies are necessary to validate their utility. Finally, pars plana vitrectomy is the treatment of choice when vitreomacular traction and/or epiretinal membrane is present.

Maculopathy associated with Prior Tamoxifen Use Diagnosed with Commercially Available Fourier-Domain Optical Coherence Tomography: A Case Series

Introduction: Tamoxifen retinopathy is usually diagnosed on fundoscopy and fluorescein angiography. Microcystoid maculopathy associated with tamoxifen was reported previously using a research-grade high resolution Fourierdomain optical coherence tomography (Fd-OCT) in a patient with vision loss unexplained on fundoscopy, fluorescein angiography and Stratus OCT. This report describes two new cases of microcystoid maculopathy diagnosed using commercially available Fd-OCT in patients who have been previously treated with tamoxifen. Case presentation: Two patients had visual complaints which started while on tamoxifen but persisted or worsened after stopping tamoxifen at least two years earlier. Both patients had normal or near normal visual acuity and fundoscopy. Fluorescein angiography was normal in all but one eye which showed foveal hyperfluorescence. No angiographic cystoid macular edema was noted. Commercially available Fd-OCT (RTVue and Cirrus) showed microcystoid changes in the central macula with patches of loss of photoreceptor inner segment-outer segment junction (IS-OS) near the fovea in all four eyes. The eye with foveal hyperfluorescence on fluorescein angiography had foveal detachment on Fd-OCT in addition which resolved spontaneously on follow-up Fd-OCT nine months later. The microcystoid changes and IS-OS loss persisted on follow-up Fd-OCT. Conclusion: Maculopathy associated with prior tamoxifen use may be detected using commercial Fd-OCT though not evident on fundoscopy or fluorescein angiography. Maculopathy may persist over 2 years after stopping tamoxifen.

Incidence of postoperative cystoid macular edema by a single surgeon.

To evaluate the clinical and angiographic incidence of cystoid macular edema (CME) after cataract surgery, and to determine the impact of intraoperative triamcinolone acetonide. This is a prospective, single-center trial looking at 81 eyes of 61 patients who underwent clear-cornea incision phacoemulsification with lens implantation under topical anesthesia by a single surgeon. Outcome measures included clinical and angiographic CME, the impact of operative time, medications, and systemic disease on the presence of CME. Eight eyes (9.87%) demonstrated angiographic CME at the one-week and six-week follow-up visits. Two eyes showed evidence of clinical CME (2.46%) on examination. Subjects with diabetes had an increased risk of angiographic CME. The incidence of clinically significant and angiographic CME in this study is confirmatory of previous studies in the literature. The use of intraoperative subconjunctival triamcinolone acetonide did not appear to significantly reduce the development of post-operative CME.

TOPICAL NEPAFENAC AS AN ALTERNATE TREATMENT FOR CYSTOID MACULAR EDEMA IN STEROID RESPONSIVE PATIENTS

To evaluate the use of nepafenac 0.1% in patients with cystoid macular edema who are known steroid responders. Patients (N = 15) with clinical and angiographic cystoid macular edema (> or = 2 months) and a history of increased intraocular pressure following administration of topical corticosteroids participated in this prospective, open-label, pilot study. All patients were treated with nepafenac 0.1% four times daily for 6 weeks and the dose was tapered off over the ensuing 6 weeks. The total treatment duration was 12 weeks. Visual acuity and retinal thickness were measured. For the entire population, there was a mean significant improvement in visual acuity and retinal thickness at 4 weeks and 12 weeks posttreatment compared with baseline (P < 0.0001). A subgroup analysis revealed that patients with pseudophakic cystoid macular edema (n = 11) had a mean significant improvement in visual acuity and retinal thickness compared with baseline at 4 weeks and 12 weeks posttreatment (P < 0.0001). Although the improvement in the vitreoretinal interface disorders group was not statistically different from baseline (probably due to the outlier), three of the four patients with vitreoretinal interface disorders had improvement in visual acuity and retinal thickness. Nepafenac was well tolerated. Nepafenac may be an effective and safe therapy for treating chronic cystoid macular edema in patients who are steroid responders.

Reducing angiographic cystoid macular edema and blood–aqueous barrier disruption after small-incision phacoemulsification and foldable intraocular lens implantation: Multicenter prospective randomized comparison of topical diclofenac 0.1% and betamethasone 0.1%

To compare the effectiveness of a topical nonsteroidal drug (diclofenac 0.1%) and a topical steroidal drug (betamethasone 0.1%) in preventing cystoid macular edema (CME) and blood-aqueous barrier (BAB) disruption after small-incision cataract surgery and foldable intraocular lens (IOL) implantation. Shohzankai Medical Foundation Miyake Eye Hospital, Tokyo, Japan. This multicenter interventional double-masked randomized study comprised 142 patients having phacoemulsification and foldable IOL implantation. Seventy-one patients were randomized to receive diclofenac eyedrops and 71, betamethasone eyedrops for 8 weeks postoperatively. The incidence and severity of CME were evaluated by fluorescein angiography. Blood-aqueous barrier disruption was determined by laser flare-cell photometry. Of the patients, 63 were men and 79 were women. Five weeks after surgery, the incidence of fluorescein angiographic CME was lower in the diclofenac group (18.8%) than in the betamethasone group (58.0%) (P<.001). At 1 and 2 weeks, the amount of anterior chamber flare was statistically significantly less in the diclofenac group than in the betamethasone group (P<.05). At 8 weeks, intraocular pressure was statistically significantly higher in the betamethasone group (P = .0003). Diclofenac was more effective than betamethasone in preventing angiographic CME and BAB disruption after small-incision cataract surgery. Thus, nonsteroidal antiinflammatory agents should be considered for routine treatment of eyes having cataract surgery.

The Effect of Topical Diclofenac on Choroidal Blood Flow in Early Postoperative Pseudophakias with Regard to Cystoid Macular Edema Formation

To study the chronological change in choroidal blood flow (ChBFlow), disruption of the blood-aqueous barrier, and incidence of cystoid macular edema (CME) in early postoperative pseudophakic eyes, as well as the effect of nonsteroidal anti-inflammatory drug (NSAID) eye drops on these phenomena. Fifty patients who underwent phacoemulsification and foldable intraocular lens (IOL) implantation were randomized to receive either topical diclofenac or fluorometholone for 5 postoperative weeks. An additional 20 subjects, with long-standing pseudophakia served as the control. The blood-aqueous barrier was examined by laser flarimetry and choroidal blood velocity (ChBVel), volume (ChBVol), and ChBFlow by laser Doppler flowmetry (LDF) at 2 days and 1, 2, and 5 weeks after surgery. The incidence and severity of CME were evaluated by fluorescein angiography at 2 and 5 weeks after surgery. Compared with patients taking diclofenac, those receiving fluorometholone showed significantly reduced ChBVol at 2 weeks (0.38 +/- 0.08 vs. 0.32 +/- 0.07, P = 0.022) and ChBFlow at 1 (11.01 +/- 1.74 vs. 9.35 +/- 1.51, P = 0.003) and 2 (11.15 +/- 1.43 vs. 8.47 +/- 1.27, P = 0.000) weeks after surgery, as well as a significantly elevated amount of anterior flare at 1 (8.9 +/- 2.2 vs. 24.4 +/- 18.9, P = 0.001) and 2 (9.2 +/- 3.5 vs. 16.7 +/- 12.3, P = 0.025) weeks after surgery. The ChBVol and ChBFlow in the fluorometholone group, however, returned to normal and was not different from the diclofenac group at 5 weeks after surgery. The incidence of fluorescein angiographic CME trended to be higher (P = 0.08) at 2 weeks and was significantly higher (P = 0.001) at 5 weeks after surgery in eyes with fluoromethalone than with diclofenac. Reduction of ChBFlow, disruption of the blood-aqueous barrier, and incidence of CME in early postsurgical pseudophakic eyes were more effectively prevented chronologically in eyes treated with diclofenac than in those treated with fluorometholone.

Preoperative topical indomethacin to prevent pseudophakic cystoid macular edema

To evaluate the effectiveness of a nonsteroidal antiinflammatory drug (NSAID) on pseudophakic cystoid macular edema (CME) and determine the efficacy when used preoperatively and after uneventful phacoemulsification surgery. Department of Ophthalmology, Kocatepe University, School of Medicine, Afyonkarahisar, Turkey. One hundred seventy-nine eyes of 189 patients having uneventful phacoemulsification surgery were enrolled in the study. After surgery, all patients used topical steroids and antibiotics 4 times daily. Sixty-one eyes, chosen randomly, received a topical NSAID (indomethacin) 4 times daily for 3 days preoperatively and 1 month postoperatively. Sixty eyes received topical indomethacin 4 times daily for 1 month postoperatively. Fifty-eight eyes served as a control group and received only topical steroids and antibiotics. At the third postoperative month, visual acuity, fluorescein angiograms, and macular thresholds were evaluated. Statistical analysis was by chi-square and 1-way analysis of variance tests. Cystoid macular edema was not seen in the group receiving indomethacin preoperatively and postoperatively. The incidence of angiographic CME was 15.0% in the group receiving postoperative indomethacin and 32.8% in the control group (P<.001). Mean sensitivity in the macular threshold test did not show a significant change between groups (P = .83). Postoperative visual acuity was significantly higher in the group receiving preoperative indomethacin (P<.001). Nonsteroidal antiinflammatory drugs decreased the incidence of CME, and their efficacy increased when begun preoperatively.

The −174G/C interleukin-6 promoter polymorphism influences the development of macular oedema following uncomplicated phacoemulsification surgery

To determine whether the functional -174 G/C interleukin-6 gene polymorphism is a risk factor for the development of cystoid macular oedema (CMO) following routine uncomplicated phacoemulsification surgery in patients with no established risk factors. A total of 40 patients who underwent routine phacoemulsification surgery as part of a randomised controlled trial comparing the use of postoperative steroid drops against a single sub-tenon injection of triamcinolone were genotyped for the IL-6 -174G/C polymorphism. All patients underwent fluorescein angiography at 30 days and anterior chamber flare measurements pre-operatively and at day 1, 7, and 30. Angiographic CMO developed in 14 patients of the 40 studied. 9 out of the 14 patients carried the GG genotype (Fisher's exact test P=0.05, Hazard ratio for GG genotype; 4.05 (1.02-16.00)). There was no difference in flare measurements between the GG and Non-GG (GC/CC) group. The two groups were otherwise well matched in terms of age, sex, phacoemulsification energy used intraoperatively, and proportion of patients receiving postoperative triamcinolone or steroid drops. The -174G/C interleukin-6 promoter gene variant appears to modulate the response to phacoemulsification surgery and to influence the development of postoperative CMO. These data suggest a genetic predisposition to this complication.

Cystoid macular oedema following pneumatic retinopexy vs scleral buckling

To determine the incidence of angiographic cystoid macular oedema (CMO) following pneumatic retinopexy (PR) and scleral buckling (SB) in consecutive case series. Patients who had successful anatomical attachment following PR and SB were included in our study; 132 patients had PR and 121 patients had SB. We evaluated the demographic characteristics, visual acuity, lens status, macular status, and previous ocular history in all patients. CMO was evaluated by fluorescein angiography (FA) in a masked pattern, 6 and 12 weeks after surgery in all cases. We analysed the CMO incidence and its correlation with preoperative ocular status and visual outcome. Chi2 and Fisher's exact tests were used in statistical analysis. CMO was present in 15 of 132 (11%) PR, and 35 of 121 (29%) SB patients at 6 weeks (P=0.0005); the oedema was persistent in eight of 132 (6%) PR and 21 of 121 (17%) SB patients at 12 weeks (P=0.0005). Eight of 106 (8%) phakic and seven of 26 (27%) pseudophakic patients developed CMO following PR (P=0.02). In the SB group, 26 of 72 (36%) patients who had preoperative macular detachment developed CMO (P=0.03). Visual improvement was limited in patients who developed angiographic CMO despite anatomical re-attachment of the retina. CMO may occur following both PR and SB and deteriorate the visual outcome. Previous cataract surgery and macular detachment may increase the CMO rates following PR and SB, respectively.

Prognostic factors for visual acuity improvement after intravitreal triamcinolone injection

In some patients with macular oedema, intravitreal triamcinolone acetonide injection (IVTA) fails to improve visual acuity, although oedema shows clinical and angiographic improvement. Side effects can include increased intraocular pressure, cataract development, and (rarely) endophthalmitis. Our purpose was to identify prognostic factors for visual acuity improvement after IVTA. Data on patients treated by IVTA for macular oedema were retrospectively reviewed. Three months postinjection, visual acuity was rated as 'improved' (two or more Snellen lines gained) or 'nonimproved' (unchanged or worsened). Comparative demographic data and pre- and post-IVTA clinical and fluorescein angiographic findings were analysed with SPSS software. Of 57 eyes (57 patients), 27 (47%) improved after IVTA. Initial visual acuity ('good', 'moderate', or 'poor') and aetiology of macular oedema (diabetic, venous occlusion, or pseudophakic) did not differ between the two groups. Improvement occurred in significantly more eyes with clinical or angiographic evidence of cystoid macular oedema (CME) than in those with diffuse retinal thickening (P=0.04) or diffuse leakage on fluorescein angiography (P=0.02), respectively, and in significantly more pseudophakic than phakic eyes (P=0.046). Pseudophakia and clinical or angiographic CME, but not aetiology or initial visual acuity, were prognostic of visual acuity improvement after IVTA for macular oedema.

Blood-Aqueous Barrier Changes After the Use of Prostaglandin Analogues in Patients With Pseudophakia and Aphakia

To investigate the effects of prostaglandin analogues on the blood-aqueous barrier and to evaluate the occurrence of cystoid macular edema in aphakic or pseudophakic patients with glaucoma. In this randomized, masked-observer, 6-month clinical trial, patients with primary open-angle, pseudophakic, or aphakic glaucoma were treated once daily with bimatoprost (n = 16), latanoprost (n = 15), or travoprost (n = 17) or twice daily with unoprostone (n = 16) or lubricant drops (control group) (n = 16). Blood-aqueous barrier status, which was assessed using a laser flare meter; intraocular pressure; the occurrence of angiographic cystoid macular edema; and conjunctival hyperemia were evaluated. Mean flare values were significantly higher in the bimatoprost, latanoprost, and travoprost groups throughout follow-up (P < .02). Four latanoprost-treated eyes, 1 bimatoprost-treated eye, and 1 travoprost-treated eye developed cystoid macular edema; all cases resolved after discontinuation of the prostaglandin analogue and treatment with topical diclofenac sodium. Mean intraocular pressure reductions after 6 months were higher for the latanoprost (26%), bimatoprost (28%), and travoprost (29%) groups than for the control (3%) and unoprostone (14%) groups (P< .05). Bimatoprost induced significantly higher hyperemia scores than latanoprost, unoprostone, and placebo (P< .01). Bimatoprost, latanoprost, and travoprost use may lead to disruption of the blood-aqueous barrier in patients with pseudophakia and aphakia.

Serous macular detachment in diabetic cystoid macular oedema

To define serous macular detachment in patients with diabetic cystoid macular oedema (CME). This study involved 78 eyes of 58 patients with diabetic CME. The patients underwent complete ophthalmic examination, fluorescein angiography and optical coherence tomography (OCT). Eyes with epiretinal membrane or vitreo-macular traction were not included in the study. Optical coherence tomography-3 was used in all patients and fundi were scanned on the horizontal, vertical and four oblique planes through the centre of the fovea. In all cases the increased thickness of the retina was related primarily to the hyporeflective intraretinal cavities. With OCT, 24 of 78 eyes (31%) had serous macular detachment as shown by retinal elevation over a non-reflective cavity with minimal shadowing of the underlying tissues. Fluorescein angiography did not show serous macular detachment in any patient. Our data showed that the incidence of serous macular detachment in diabetic CME was much higher than previously reported. Optical coherence tomography-3 allows an in vivo cross-sectional observation of very subtle serous macular detachment that is difficult to diagnose at the slit-lamp or by fluorescein angiography in patients with diabetic CME.

Incidence of Cystoid Macular Edema after Uncomplicated Phacoemulsification

We determined the incidence and causes of clinical and angiographic cystoid macular edema (CME) after uncomplicated phacoemulsification and intraocular lens implantation in otherwise normal eyes. This study comprised 252 eyes of 252 patients who had uncomplicated phacoemulsification with continuous curvilinear capsulorhexis and in-the-bag acrylic intraocular lens implantation. The presence of clinical and angiographic CME was evaluated 45 days after surgery, using fundus fluorescein angiography. Age, sex, cataract type, iris color, and real phacoemulsification time of the patients were also recorded. The mean age of the patients was 69.86 (range 60–82) years). Clinical CME was not detected in any eye at any postoperative visit. There were 23 cases with angiographic CME (9.1%). There were no significant differences between the groups who were later found to be angiographically CME-positive or CME-negative in any variable recorded (p >0.05). The incidences of clinical and angiographic CME after uncomplicated phacoemulsification were 0 and 9.1%, respectively. These results indicate that the occurrence of clinical CME has greatly reduced after uncomplicated phacoemulsification operations, but the incidence of angiographic CME is still nearly equal to the incidence of the extracapsular technique.

Photodynamic therapy of circumscribed choroidal hemangioma

Purpose To evaluate the safety and effectiveness of photodynamic therapy (PDT) in the treatment of symptomatic circumscribed choroidal hemangiomas (CCH) of the posterior pole. Design Prospective, consecutive, noncomparative case series. Participants Ten eyes of 10 patients (six males and four females; age range, 38–64 years) reporting visual impairment caused by intraocular CCH. Follow-up was 7 to 16 months. Methods Photodynamic therapy was applied by Zeiss laser (Visulas 6905, Carl Zeiss-Meditech AG, Jeud Germany) emitting a light at 689 nm for photosensitization and by using verteporfin (Visudyne; Novartis Ophthalmics AG, Basel, Switzerland) at a dose of 6 mg/m 2 body surface administered intravenously before treatment. The diameter of the treatment spot was calculated on early frames of pretreatment indocyanine green angiography; the maximum treatment spot diameter was 6000 μm using a Mainster wide-field lens (Ocular Instruments Inc., Bellevue, WA USA). In the case of peripapillary CCH, the laser spot was applied at a distance of 200 μm from the optic disc edge. A laser beam was applied to the retina 15 minutes after the start of the infusion. Two different treatment procedures were used according to the height of the lesion. A radiant exposure of 100 J/cm 2 with an exposure time of 186 seconds was applied to lesions larger than 2 mm. For lesions smaller than 2 mm, a radiant exposure of 75 J/cm 2 with an exposure time of 125 seconds was used. Main outcome measures Visual outcomes, pretreatment findings, and final findings were evaluated using biomicroscopy, fluorescein angiography (FA), indocyanine green angiography (ICGA), and ultrasound. Results After a follow-up of 7 to 16 months, FA and ICGA verified the nonperfusion of the vascular channels of the tumor in the treated areas. No retinal pigment epithelium (RPE) changes were observed in the patients who had undergone two PDT treatments, whereas minimal alterations were detected in two of the four patients who had undergone three treatment sessions. Angiographic cystoid macular edema and exudative macular detachment had completely regressed in all cases. Minimal intraretinal edema was observed on the FA frames in two cases. Ultrasound examination found no measurable tumor height in six (60%) cases and a marked reduction in the remaining four cases, even after one treatment (post treatment tumor height range, 0.86–1.82 mm). An improvement in visual acuity (one to six lines on the Early Treatment for Diabetic Retinopathy Study chart) was observed in all the cases. In four cases, the visual acuity returned to 20/20, of which three were extrafoveal and one was subfoveal with visual impairment caused by secondary exudative macular detachment without significant RPE alterations. Also in longstanding subfoveal cases, a marked visual acuity improvement was detected resulting from the disappearance of subretinal or intraretinal fluid, even if functional results were limited by pre-existing RPE alterations. In all cases no damage to retinal vessels was observed. Conclusions Photodynamic therapy is a minimally invasive but effective method of treatment for CCH and may be considered as a treatment of choice, especially in patients with foveal location of the tumor. Because of its safety and repeatability, this technique can be used to treat frequent recurrences of the tumor.

Cystoid macular edema after phacoemulsification: relationship to blood–aqueous barrier damage and visual acuity

PurposeTo ascertain the incidence of cystoid macular edema (CME) after phacoemulsification and its relationship to blood–aqueous barrier damage and visual acuity. SettingA British teaching hospital. MethodsA prospective trial was performed to document the incidence of CME after routine phacoemulsification with continuous curvilinear capsulorhexis. LogMAR visual acuity and laser flare were measured using the KOWA FC 1000 laser cell–flare meter preoperatively and 1, 14, 30, and 60 days postoperatively. At day 60, a standardized fluorescein angiogram was performed and graded by masked observers. ResultsThe rate of angiographic CME on day 60 was 19%. Visual acuity at each visit was significantly worse in the CME group (P < .05). The flare and cell values at days 14, 30, and 60 were higher in the CME group at day 60; however, the difference was not statistically significance (P > .05). ConclusionsThe incidence of CME after routine phacoemulsification was 19%. Patients with CME at day 60 had significantly worse visual acuity than those who did not from the first postoperative day throughout the follow-up. There was a trend for patients who had CME at day 60 to have more postoperative inflammation.