Baseline Central Macular Thickness Research Articles

Optical biometry-based axial length alterations after intravitreal dexamethasone implant.

To investigate changes in axial length after intravitreal dexamethasone implantation in patients with macular edema. We performed a prospective comparative study of 46 patients with unilateral macular edema, due to diabetic retinopathy, retinal vein occlusion, and non-infectious uveitis, who underwent dexamethasone implantation. The fellow eyes of the patients were considered the control group. The central macular thickness was measured by spectral-domain optical coherence tomography, and axial length was measured by IOLMaster 700 optical coherence biometry. We compared axial length and central macular thickness values within the groups. In the study group, the baseline central macular thickness was 460.19 ± 128.64 mm, significantly decreasing to 324.00 ± 79.84 mm after dexamethasone implantation (p=0.000). No significant change in central macular thickness measurements was seen in the control group (p=0.244). In the study group, the baseline axial length was 23.16 ± 0.68 mm, significantly increasing to 23.22 ± 0.65 mm after dexamethasone implantation (p=0.039). However, the control group exhibited no significant change in axial length (p=0.123). In addition to significantly reducing central macular thickness measurements, intravitreal dexamethasone implantation also significantly changes optical biometry-based axial length measurements.

Clinical Use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion Compared with Intravitreal Anti-Vascular Endothelial Growth Factor.

Objectives:Branch retinal vein occlusion (BRVO) is the second most common type of retinal vascular disorder. Both inflammation and increased vascular endothelial growth factor (VEGF) levels play important roles in the pathogenesis of macular edema (ME) secondary to BRVO. The aim of this study was to compare the efficacy of 0.7-mg intravitreal dexamethasone implants with continued anti-VEGF treatment in patients with ME secondary to BRVO who were poor responders to at least 6 previous anti-VEGF injections.Methods:Patients exhibiting an insufficient response to at least 6 ranibizumab treatments and who subsequently underwent a dexamethasone implant were included Group 1. Patients who were at risk for cataract or glaucoma continued treatment with the same drug and were defined as Group 2. The best corrected visual acuity (BCVA) and central macular thickness (CMT) changes at month 2, 4, and 6 were measured.Results:Ninety eyes were evaluated. In Group 1, the mean baseline BCVA of 0.71±0.75 logarithm of the minimum angle of resolution (logMAR) improved to 0.53±0.62 logMAR at month 2 (p<.001), 0.67±0.72 logMAR at month 4 (p=0.325), and 1.03±0.83 logMAR at month 6 (p=.001). In Group 2, the mean baseline BCVA was 0.73±0.83 logMAR, and improved to 0.68±0.83 logMAR at month 2 (p=0.12), 0.698±0.81 logMAR at month 4 (p=0.270), and 0.76±0.80 at month 6 (p=0.546). The baseline CMT in each group was 588±176 μm and 545±165 μm, respectively (p=0.248). The mean CMT of Group 1 changed from a baseline measurement of 588±176 μm to 308±132 μm at month 2 (p<.001), 450±195 μm at month 4 (p<.001), and 510±190 μm at month 6 (p<.001). The mean CMT of Group 2 changed from a baseline value of 545±165 μm to 486±162 μm at month 2 (p<.001), 516±168 μm at month 4 (p<.001), and 528±171 μm at month 6 (p=0.037).Conclusion:Dexamethasone implants were a more effective treatment for patients with BRVO-related resistant ME than ranibizumab at month 2. However, this positive effect seems to decline rapidly in the long term.

Focal laser application versus bevacizumab for treatment of central serous chorioretinopathy

Aim To report and compare the efficacy of macular grid laser versus intravitreal bevacizumab injection (IVBI) in patients with central serous chorioretinopathy (CSCR). Patients and methods A prospective study on 36 eyes of 35 patients with CSCR was conducted. The diagnosis of CSCR was established by fluorescein angiography and optical coherence tomography (OCT). All patients underwent measurement of best-corrected visual acuity, intraocular pressure, dilated fundus examination, and (OCT) imaging at baseline and follow-up visits. Fluorescein angiography was performed at baseline visit and thereafter depending on clinical and OCT findings. Patients were classified into group A, comprising 19 patients who were treated with macular grid laser and group B, comprising 17 patients who were treated with IVBI. The outcome measures were the resolution of neurosensory detachment, improvement in visual acuity, and resolution of leakage. All cases were evaluated after 3, 6, 12, and 24 weeks. Data were classified into two groups and statistically analyzed. Results In group A, the mean age of patients was 43.6 years (range, 23–52 years), there were 11 (57.89%) males and eight (42.10%) females, and the mean of follow-up period was 9.2 months (range, 7–18 months). The mean log MAR visual acuity score improved from 0.8 to 0.40 after 3 months of follow-up. The mean baseline central macular thickness (CMT) was 466 µm (range, 358–576 µm), which decreased to 309 µm (range, 268–356 µm) after 6 weeks, with statistically significance difference change from the baseline, and to 247 µm (range, 225–319 µm) after 3 months, with statistically significance difference change from the baseline (P Conclusion Both macular grid laser and IVBI for CSCR can lead to improvements of visual acuity and hasten recovery period. Macular grid laser may be considered as effective as anti-vascular endothelial growth factor for treatment of CSCR. More studies using larger scales may be needed to clarify the uncertain relationship between pathogenesis and results of treatment.

Single-Session Low Duration Panretinal Photocoagulation Using Conventional Laser on Central Subfield Macular Thickness in Diabetic Retinopathy

Objective:To compare the change in central subfield macular thickness following single-session and multiple-session laser panretinal photocoagulation in subjects with diabetic retinopathy.Methods:A single-center, randomized controlled trial study was performed on 28 eyes of 16 patients with severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy. Eyes were randomly assigned for treatment with panretinal photocoagulation performed either in single-session or multiple-session divided into three sessions during two-week period. Central subfield macular thickness was quantified using spectral domain optical coherence tomography and changes at four weeks follow-up were compared to the baseline measurement.Result:Mean baseline central subfield macular thickness of 12 eyes underwent single-session and 16 eyes underwent multiple-session panretinal photocoagulation were 342.91+109.51 micrometers and 354+171.79 micrometers (p&gt; .05), respectively. Mean post laser central subfield macular thickness in the single-session group was 305.83+81.95 micrometers and 389.75+229.51 micrometers in the multiple-session group (p&gt; .05). Mean central subfield macular thickness changes four weeks post laser was 37.08+94.21 micrometers for eyes treated with single-session and -35.75+123.62 micrometers for the multiple-session treated eyes (p= .101).Conclusion:There was no significant difference in change of central subfield macular thickness at four weeks post laser from treatment with single-session and multiple-session panretinal photocoagulation. Single-session panretinal photocoagulation can be used as effective multiple-session panretinal photocoagulation for the treatment of diabetic retinopathy.

Going green - treatment outcome and safety profile of chronic central serous chorioretinopathy treated with subthreshold green laser.

AimSubthreshold lasers have gained popularity in the treatment of chorioretinopathy central serous chorioretinopathy (CSCR) and yellow (577 nm) lasers have completely revolutionized the treatment. However, there is very little literature regarding the use of a more common and conventional – green (532 nm) subthreshold laser for the treatment of chronic CSCR. We report the use of green (532 nm) laser for the treatment of chronic CSCR and its outcome.MethodsEyes with nonresolving CSCR were treated with green subthreshold laser and evaluated at the end of 5 months. Visual acuity, central macular thickness (CMT), and macular volume (MV) at baseline and at 5 months following treatment were evaluated.ResultsThirteen eyes with chronic CSCR were treated with green laser in SP-Mode™. The mean duration of CSCR was 7.64±3.77 months at the time of treatment. The median age of the patients was 41 (35–57) years. The baseline mean best-corrected visual acuity (BCVA) was 0.96 logMAR ± 0.17, with mean baseline CMT of 503.8 μm ± 181.9 and MV of 12.8 mm3 ± 3.81. The mean CMT at 5 months was 211 μm ± 31.7 and mean MV was 9.65 mm3 ± 0.60, correlating to a mean decrease of 292 μm ± 79 in CMT and mean decrease of 3.18 mm3 ± 1.87 in the MV from baseline (P<0.05). The mean BCVA after treatment was 0.18 logMAR±0.09 (P<0.05). Two cases of CSCR with pigment epithelial detachment (PED) also had complete resolution of both at 5 months.ConclusionSubthreshold green laser (532 nm) is a safe and effective modality for the treatment of chronic CSCR with very good and stable outcomes. It may also be beneficial in the treatment of PEDs.

Comparison of one and three initial monthly intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion.

To compare three initial monthly intravitreal ranibizumab (IVR) injections followed by pro re nata (PRN) dosing with one initial monthly IVR injections followed by PRN dosing for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Forty-two eyes of 42 patients who had IVR injections for BRVO were retrospectively studied. Eighteen eyes received 1 initial IVR injection (1+PRN group) and 24 eyes received 3 monthly IVR injections (3+PRN). At 1, 3, 6 and 12mo; spectral-domain optical coherence tomography (SD-OCT) was performed. Central macular thickness (CMT), the integrity of the external limiting membrane (ELM), the presence of subretinal fluid, cyst size, the presence of inner segment/outer segment (IS/OS) defect were determined. At baseline the mean CMT was 521.3±153.2 µm in the 3+PRN group while it was 438.1±162.4 µm in 1+PRN group. At the final visit, mean CMT was 278.3±87.8 µm in the 3+PRN group and 285.2±74.2 µm in the 1+PRN group (P=0.079). The changes in CMT over the entire study period were also comparable in both groups (243±160 µm in the 3+PRN group, and 152.9±175.3 µm in the 1+PRN group; P=0.090). At baseline, best-corrected visual acuity (BCVA) was 0.92±0.60 logarithm of the minimal angle of resolution (logMAR) in the 3+PRN group, while it was 0.72±0.46 logMAR in the 1+PRN group. Final BCVA was 0.42±0.55 logMAR in the 3+PRN group and 0.38±0.50 logMAR in the 1+PRN group (P=0.979). Additionally, the BCVA changes from baseline to final visit were not significantly different (-0.50±0.45 logMAR in the 3+PRN group, and -0.33±0.39 logMAR in the 1+PRN group; P=0.255). No significant differences in the anatomical or functional results are found between 3+PRN and 1+PRN regimens in the patients receiving ranibizumab for ME secondary to BRVO. Intact IS/OS and baseline BCVA are good predictor of the visual gain, while baseline CMT is a good predictor of the anatomical gain.

Intravitreal aflibercept therapy in eyes with chronic central serous chorioretihopathy: Short term results

Abstract Objectives To evaluate the short term efficacy and tolerability results of intravitreal aflibercept injection as a treatment option for eyes with chronic central serous chorioretinopathy (CSCR). Materials and methods A prospective longitudinal study. Ten eyes of 10 patients with chronic CSCR who had been followed for >6 months after the first intravitreal injection of aflibercept were recruited for the study. The best corrected visual acuity (BCVA) and central macular thickness (CMT) values obtained by spectral-domain optical coherence tomography were recorded at baseline and the first, third, and sixth months after the injection. Results The mean logMAR BCVA was 0.70 ± 0.25 at baseline. At the first, third, and sixth months after the injection, the mean logMAR BCVA were 0.39 ± 0.36, 0.32 ± 0.39, and 0.29 ± 0.34, respectively. The mean and median BCVA over the entire follow-up period was significantly improved compared with baseline BCVA (p The mean CMT was 449.30 ± 142.53 μm at baseline. It was measured as 302.60 ± 72.28 μm on the first month, 294.30 ± 72.85 μm on the third month, and 294.60 ± 83.84 μm on the sixth month after the injection. The mean and median CMT during the entire follow-up period was significantly decreased compared with baseline CMT (p Conclusions Short-term results of this study demonstrate that intravitreal aflibercept may be used as a treatment option to improve the BCVA and reduce the CMT in chronic CSCR.

Evaluation of the effect of combined intravitreal ranibizumab injection and sub-tenon steroid injection in the treatment of resistant diabetic macular edema.

To compare sub-tenon steroid plus anti-VEGF injection with anti-VEGF injection solely in the treatment of resistant diabetic macular edema (DME). Patients who exhibited insufficient anatomic [over 350μm central macular thickness (CMT)] and less than 3 lines of visual gain at least six anti-VEGF injections, were randomly divided into two groups. In group I, the anti-VEGF injection was performed 10days after the sub-tenon steroid injection [Triamcinolone acetonide (Sinakort-A®)]. And anti-VEGF was performed when needed during the follow-up period. In group II, treatment was continued with anti-VEGF only. All patients' visual acuity and CMT were followed up for 6months. The baseline BCVA in group I and group II was 0.51 ± 0.667 logMAR and 0.47 ± 0.60 logMAR, respectively (p = 0.52). In group I and II, at the end of 6-month follow-up, BCVA improved to 0.38 ± 0.60 logMAR (p < 0.001) and 0.43 ± 0.60 logMAR (p = 0.20), respectively. The baseline CMT in group I and group II was 494 ± 118.32 and 438.20 ± 90.99μm, respectively (p = 0.029). In group I and II, at the end of 6months, CMT decreased to 302.57 ± 69.89μm (p < 0.001) and 439.20 ± 107.6μm (p = 0.96), respectively. Adding steroid to routine anti-VEGF treatment is an effective way of treatment method for resistant DME.

Ranibizumab for the Treatment of Diabetic Macular Oedema in the Real-World Clinical Setting in Portugal: A Multicentre Study

Purpose: The purpose of this study was to evaluate the 2-year outcome of ranibizumab for diabetic macular oedema (DME) in the real-life clinical practice of five ophthalmology departments of the National Health Service (NHS) in Portugal. Methods: This is a retrospective multicentre study. The clinical records on consecutive patients with DME from clinical practice treated with 0.5 mg intravitreal ranibizumab and followed up for 24 months were reviewed. Efficacy outcomes comprised the change in best corrected visual acuity (BCVA) and central macular thickness (CMT) evaluated by SD-OCT. Multivariate regression analysis was performed to explore predictors of BCVA. Results: A total of 122 eyes of 93 patients were included. The median BCVA change by 24 months was +5.0 letters (IQR 12.0) (p < 0.001) and the CMT change was –89.0 µm (IQR 165.0) (p < 0.001). By 24 months, 21.4% of the eyes had gained ≥15 letters and 8.6% had lost ≥15 letters. The median number of injections given during follow-up was 5.0 (IQR 4.0). A greater baseline CMT and a more disrupted status of the external limiting membrane were predictive of worse BCVA at 24 months (p ≤ 0.015). Conclusion: DME treatment with ranibizumab in the Portuguese NHS is associated with anatomic and functional improvement by 2 years; however, our results are below those reported in major clinical trials, and undertreatment is probably the cause.

Terapia intravítrea con aflibercept en ojos con coriorretinopatía serosa central crónica: resultados a corto plazo

ObjectivesTo evaluate the short term efficacy and tolerability results of intravitreal aflibercept injection as a treatment option for eyes with chronic central serous chorioretinopathy (CSCR). Material and methodsA prospective longitudinal study. Ten eyes of 10 patients with chronic CSCR who had been followed for >6months after the first intravitreal injection of aflibercept were recruited for the study. The best corrected visual acuity (BCVA) and central macular thickness (CMT) values obtained by spectral-domain optical coherence tomography were recorded at baseline and the first, third, and sixth months after the injection. ResultsThe mean logMAR BCVA was 0.70±0.25 at baseline. At the first, third, and sixth months after the injection, the mean logMAR BCVA were 0.39±0.36, 0.32±0.39, and 0.29±0.34, respectively. The mean and median BCVA over the entire follow-up period was significantly improved compared with baseline BCVA (P<.05 for each one).The mean CMT was 449.30±142.53μm at baseline. It was measured as 302.60±72.28μm on the first month, 294.30±72.85μm on the third month, and 294.60±83.84μm on the sixth month after the injection. The mean and median CMT during the entire follow-up period was significantly decreased compared with baseline CMT (P<.05 for each one). None of the patients had any serious ocular or systemic side effects over the course of the study. ConclusionsShort term results of this study demonstrate that intravitreal aflibercept may be used as a treatment option to improve the BCVA and reduce the CMT in chronic CSCR.

Intravitreal Bevacizumab with or without Triamcinolone for Wet Age-related Macular Degeneration: Twelve-month Results of a Prospective, Randomized Investigation.

PURPOSE:The purpose of this study is to compare the long-term outcomes of intravitreal bevacizumab (IVB) with a combination therapy including IVB/intravitreal triamcinolone acetonide (IVB/IVTA) in neovascular age-related macular degeneration (AMD).MATERIALS AND METHODS:This prospective, randomized clinical trial was conducted on 136 eyes of 136 patients with neovascular AMD. Eyes were randomly assigned to receive IVB alone (71 eyes) or in combination with IVTA (65 eyes). In the IVB group, three consecutive injections of 1.25 mg/0.05 ml of bevacizumab were administered 1 month apart, whereas in the IVB/IVTA group, 4 mg/0.05 mL of triamcinolone acetonide was added to bevacizumab in the first injection. Additional IVB injections were administered in eyes demonstrating active choroidal neovascularization. Best-corrected visual acuity (BCVA) and optical coherence tomography were performed at baseline as well as at all follow-up visits.RESULTS:No differences were seen between the patients receiving IVB and those receiving IVB/IVTA in terms of baseline BCVA (P = 0.97) and baseline central macular thickness (CMT) (P = 0.77). BCVA improved, and CMT reduced significantly in both study arms at almost all follow-up intervals. IVB/IVTA intervention, compared with IVB, was statistically more effective in improving BCVA (P = 0.01) and in reducing CMT (P = 0.02) after 12 months. The average number of reinjections was 1.25 ± 0.92 in the IVB group and 1.06 ± 1.01 in the IVB/IVTA group (P = 0.44).CONCLUSION:Our results suggest that the synergistic effect of intravitreal triamcinolone and IVB for treatment of neovascular AMD shows itself most apparently after 8 months of follow-up.

Diyabetik Maküler Ödemde İntravitreal Bevacizumab ile Kombine Bevacizumab ve Maküler Fotokoagülasyon'un Karşılaştırılması

Objective: To compare the efficacy of intravitreal bevacizumab with combined bevacizumab followed by sequential macular laser photocoagulation in the treatment of diabetic macular edema. Material and Methods: Thirty-one eyes injected with intravitreal bevacizumab and 30 eyes with combined therapy of bevacizumab injection and macular laser photocoagulation were included in this retrospective study. The main outcome measures were visual acuity, central macular thickness and the number of injections. Results: Each participant completed at least 6 months of follow-up. Baseline best-corrected visual acuity and central macular thickness values of the bevacizumab monotherapy group were similar to those of the combination group. In bevacizumab monotherapy group, baseline best-corrected visual acuity (0.91±0.65 logMAR) improved to 0.73±0.55 logMAR at 3 months and to 0.68±0.53 logMAR at 6 months of follow-up. Baseline central macular thickness decreased from 431.65 ±108.19 μm to 381.77±113.29 μm at 3 months and to 366.82±105.13 μm at 6 months. In the combination group, baseline best-corrected visual acuity improved from 0.84±0.63 logMAR to 0.55±0.48 logMAR at 3 months and to 0.41±0.46 log-MAR at 6 months, while baseline central macular thickness decreased from 400.77±119.05 μm to 287.10 ± 67.99 μm at 3 months and to 265.24±81.48 μm at 6 months following the treatment. Conclusion: Both treatment modalities were effective in improving visual acuity and reducing central macular thickness. Adding macular laser to intravitreal bevacizumab appeared to be superior to bevacizumab alone in eyes with diabetic macular edema.

Aflibercept for macular edema after branch retinal vein occlusion

Purpose The aim was to evaluate the real-world results of aflibercept in the treatment of macular edema due to branch retinal vein occlusion (BRVO) without prior treatment. Patients and methods The study included patients with treatment-naive symptomatic BRVO causing macular edema with a best corrected visual acuity (VA) of 0.1 or better, central macular thickness (CMT) of more than 300 μm, and a duration less of than 6 months. Patients received intravitreal 2.0 mg of aflibercept. Follow-up examinations were performed monthly after the first injection for at least 6 months. At each visit, complete examination and optical coherence tomography scans were performed with recording of the best corrected VA and CMT on optical coherence tomography. At the monthly follow-up visits, additional Aflibercept injections were given as needed (pro-re-nata) when intraretinal/subretinal fluid was still present. Results A total of 25 patients were included in the study. Their age ranged from 42 to 75 years with a mean of 61.12±8.34 years. There were 16 men and nine women. Duration of vein occlusion ranged from 10 to 50 days with a mean of 21.8±12.29 days. Baseline logarithm of the minimal angle of resolution VA mean was 0.790±0.16. It improved at the 6-month follow-up visit to 0.244±0.22, which was statistically significant (P=0.001). Baseline CMT mean was 538.84±186.96 µm. It improved at the end of follow-up to 284.680±68.22 µm, which was statistically significant (P=0.001). Conclusion Aflibercept given with pro-re-nata regimen was safe and effective in the treatment of macular edema after BRVO.

Efficacy of carbonic anhydrase inhibitors in management of cystoid macular edema in retinitis pigmentosa: A meta-analysis.

BackgroundCarbonic anhydrase inhibitors (CAI) are often used in the treatment of cystoid macular edema (CME) in retinitis pigmentosa (RP) patients. The aim of this meta-analysis is to gain a better understanding of the overall efficacy of CAI treatment.MethodsDatabases including PubMed, EMBASE, and Cochrane Library were searched to identify relevant studies. Eligible studies were clinical trials of patients with RP assigned topical or oral CAIs such as dorzolamide and acetazolamide. Changes in central macular thickness (CMT) by OCT in μm and best-corrected visual acuity (BCVA) in log MAR equivalents were extracted and results compared between baseline and after treatment.Results11 clinical reports were identified which included a total of 194 patients (358 eyes) available for analysis, with 59 patients (115 eyes) assigned oral CAI treatment and 135 patients (243 eyes) assigned topical CAI treatment. The combined results showed a significant reduction of macular edema, as calculated by baseline and final central macular thickness (CMT) based on OCT examination (46.02μm, 95%CI: -60.96, -31.08, I2 = 65%). However, the effect on visual acuity was inconsistent across studies.ConclusionBased on non randomized controlled clinical studies, RP patients with CME who were treated with CAIs had better anatomical outcomes, but the effect on visual acuity was contradictory across studies. Multicenter prospective randomized controlled trials would be ideal to definitively test its clinical efficacy in RP patients.

EFFECTS OF INTERNAL LIMITING MEMBRANE PEELING COMBINED WITH REMOVAL OF IDIOPATHIC EPIRETINAL MEMBRANE: A Systematic Review of Literature and Meta-Analysis.

To evaluate the effects on postoperative prognosis of internal limiting membrane (ILM) peeling in conjunction with removal of idiopathic epiretinal membranes (ERMs). MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were systematically searched for studies that compared ILM peeling with no ILM peeling in surgery to remove idiopathic ERM. Outcome measures were best-corrected visual acuity, central macular thickness, and ERM recurrence. Studies that compared ILM peeling with no ILM peeling for the treatment of idiopathic ERM were selected. Sixteen studies that included 1,286 eyes were selected. All the included studies were retrospective or prospective comparative studies; no randomized controlled study was identified. Baseline preoperative best-corrected visual acuity and central macular thickness were equal between ILM peeling and no ILM peeling groups. Postoperatively, there was no statistically significant difference in best-corrected visual acuity (mean difference 0.01 logarithm of the minimum angle of resolution [equivalent to 0.5 Early Treatment Diabetic Retinopathy Study letter]; 95% CI -0.05 to 0.07 [-3.5 to 2.5 Early Treatment Diabetic Retinopathy Study letters]; P = 0.83) or central macular thickness (mean difference 13.13 μm; 95% CI -10.66 to 36.93; P = 0.28). However, the recurrence rate of ERM was significantly lower with ILM peeling than with no ILM peeling (odds ratio 0.25; 95% CI 0.12-0.49; P < 0.0001). Currently available evidence in the literature indicates that additional ILM peeling in vitrectomy for idiopathic ERM could result in a significantly lower ERM recurrence rate, but it does not significantly influence postoperative best-corrected visual acuity and central macular thickness.

The Interval between Treatments of Bevacizumab and Dexamethasone Implants for Diabetic Macular Edema Increased over Time in the BEVORDEX Trial

To report increasing retreatment interval of intravitreal bevacizumab and dexamethasone implants for diabetic macular edema (DME) in the BEVORDEX trial. Multicenter randomized clinical trial. Sixty-eight eyes from 47 patients who completed 2 years of follow-up. The BEVORDEX study (www.clinicaltrials.gov identifier, NCT01298076), set in Australia, was the first head-to-head trial of bevacizumab (Avastin; Genentech, South San Francisco, CA), with retreatment considered after 4 weeks, versus a slow-release dexamethasone implant (Ozurdex; Allergan Inc., Irvine, CA), with retreatment possible after 16 weeks, for center-involving DME. Study eyes were assessed every 4 weeks for retreatment according to prespecified visual acuity and central macular thickness criteria. In this post hoc analysis, changes in treatment interval over time were examined using mixed-effects regression models. We assessed whether the mean treatment interval changed over time and if this depended on baseline characteristics or the treatment received. Of the 68 eyes from 47 patients, 67 study eyes received at least 1 retreatment (1 eye in the dexamethasone implant group did not require retreatment over 24 months). Thirty-two eyes received bevacizumab and 35 eyes received dexamethasone implants. Study eyes received a mean of 14.6 injections (standard deviation [SD], 7.8 injections) and 5.6 injections (SD, 1.4 injections) in the bevacizumab and dexamethasone groups, respectively, over 2 years. The mean retreatment interval over the 2-year follow-up period was 70.8 days (SD, 43.8 days) for the bevacizumab group and 145 days (SD, 45.4 days) for the dexamethasone implant group. The mean treatment interval increased over time for both drugs (P= 0.016), independent of which treatment was received (P= 0.808). Longer treatment interval over time was associated with younger age (P=0.037) and better baseline visual acuity (P= 0.026), but not with gender (P= 0.907) or baseline central macular thickness (P= 0.900). The increase in treatment interval for both intravitreal bevacizumab and dexamethasone implants over time has implications when informing patients about potential treatment burden for DME, planning intravitreal injections services, and designing future clinical trials. For drugs with a disease-modifying effect, fixed-interval dosing may not be required beyond an initial loading phase.

The outcome of low-frequency intravitreal bevacizumab therapy for macular edema in retinal vein occlusions.

AimWe aimed to evaluate the 1-year efficacy and safety of low-frequency intravitreal bevacizumab in the treatment of macular edema due to retinal vein occlusions (RVOs).MethodsThe study comprised an interventional prospective study of patients with macular edema due to central retinal vein occlusion (CRVO) or branch retinal vein occlusion, followed for 12 months. Treatment-naïve patients with reduced best-corrected visual acuity (BCVA) and central macular thickness (CMT) of at least 250 μm received intravitreal injection of bevacizumab. After 1 month, BCVA and optical coherence tomography (OCT) images of the macula were recorded. In patients with <30% improvement in BCVA and CMT, two more injections were applied at 1.5-month intervals. In all other patients, further injections were applied as needed. In cases with ischemic areas of retina, laser photocoagulation of the retina was performed.ResultsIn total, 33 patients with CRVO and 55 with BRVO were treated. After 1 year, 65 eyes (73.86%) had clinically significant improvement of BCVA (>0.3 log of the minimum angle of resolution [logMAR] units) with average number of injections of 1.98. Improvement of mean BCVA in CRVO was significant (P=0.001) from baseline (1.2±0.95 logMAR units) to 1 year (0.75±0.6 logMAR units). Significant improvement of mean BCVA (P<0.001) was also found in BRVO, from 0.71±0.75 logMAR units at baseline to 0.28±0.5 logMAR units at 1 year. Baseline CMT was 852.21±298.20 μm for CRVO and 597.95±185.63 μm for BRVO. In both groups, there was significant decrease (P<0.001) in CMT after 1 year of treatment. Panretinal laser photocoagulation was done in 75.8% of all eyes with CRVO and sectoral photocoagulation in 49.1% of eyes with BRVO.ConclusionIn macular edema due to RVO, intravitreal bevacizumab provides improvement in visual acuity and reduction of macular edema in a high percentage of treated eyes after 1 year, even with low number of injections.

Diabetic macular edema outcomes in eyes treated with fluocinolone acetonide 0.2 µg/d intravitreal implant: real-world UK experience.

To conduct an observational, multicenter study to evaluate real-world clinical efficacy and safety of the 0.2 µg/day fluocinolone acetonide (FAc) implant in the treatment of patients with chronic diabetic macular edema (DME) in 3 large hospital ophthalmology departments in the United Kingdom. Fluocinolone acetonide implants were inserted into the study eyes following a suitable washout period; phakic eyes received FAc implant following cataract surgery. Follow-up visits took place 2-4 weeks postinjection and then at 3, 6, and 12 months; change in central macular thickness (CMT) from baseline was measured by optical coherence tomography and best-corrected visual acuity (BCVA) was also assessed. Adverse events and changes in intraocular pressure (IOP) were recorded in order to evaluate the safety profile for the FAc implant. Improvements in BCVA and CMT were observed from 3 months and sustained for the duration of observation. At 12 months, the overall mean change from baseline CMT was -126 μm and mean increase in BCVA from baseline was 5.1 letters. Increases in IOP following FAc implant were easily managed with IOP-lowering medication. Implant migration into the anterior chamber occurred in 2 eyes where prior vitrectomy had resulted in a posterior capsule defect; this was rectified and resolved. The results of this study provide further efficacy and safety profile data for FAc implant treatment of chronic DME in a real-world clinical setting; the FAc implant appears to be a valuable therapeutic approach for patients with chronic DME who have suboptimal response to other treatment options.

Comparison of Conbercept with Ranibizumab for the Treatment of Macular Edema Secondary to Branch Retinal Vein Occlusion

ABSTRACTPurpose: To confirm the therapeutic efficacy of conbercept for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO).Methods: In this prospective, randomized, and comparative study, patients were randomized and divided into conbercept (n = 18) and ranibizumab (n = 17) groups. After an initial intravitreal injection of either conbercept or ranibizumab, a pro re nata (PRN) strategy was adopted based on loss of visual acuity (VA) or increase in central macular thickness (CMT).Results: All patients were followed for ≥6 months. Baseline best-corrected visual acuities (BCVAs) were 0.67 ± 0.37 and 0.511 ± 0.23 logMAR in the conbercept and ranibizumab groups, respectively (p = 0.087, t-test). Baseline CMTs were 512.5 ± 115.22 and 491.23 ± 114.72 µm in the conbercept and ranibizumab groups, respectively (p = 0.993, t-test). Significant improvements in BCVA and reduction of CMT were observed in both groups at each follow-up visit and compared to baseline values (p < 0.05, t-test). No significant differences in improvement of BCVA (p > 0.05, t-test) or reduction of CMT (p > 0.05, t-test) were noted in either group. Mean numbers of injections were 2.28 ± 0.96 and 2.65 ± 1.17 for the conbercept and ranibizumab groups, respectively (p = 0.478, t-test), with no statistically significant differences between the two groups.Conclusion: Intravitreal injection of conbercept is shown to be safe and effective for the treatment of ME secondary to BRVO, based on 6-month follow-up data.

Aqueous cytokine and growth factor levels indicate response to ranibizumab for diabetic macular oedema

Background/AimsTo investigate the relations between aqueous humour levels of cytokines/growth factors and treatment response to intravitreal ranibizumab (IVR) for diabetic macular oedema (DME)MethodsSixty-eight eyes of 68 patients with treatment-naïve centre-involved...