Central Macular Thickness In Eyes Research Articles

Efficacy and safety of intravitreal dexamethasone implant in diabetic macular edema patients with and without prior vitrectomy: a retrospective cohort study

Objective: To evaluate the effectiveness and safety of intravitreal dexamethasone implant (IDI) in diabetic macular edema (DME) patients with and without prior vitrectomy. Methods: A retrospective cohort study was conducted on DME patients who received IDI treatment at the Aier Eye Hospital, Beijing from March 2018 to August 2020. Patients were divided into two groups according to whether they had undergone vitrectomy or not. Clinical and follow-up data, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), occurrence of ocular and systemic complications, and time to DME recurrence and retreatment, were collected before and after IDI injection at 15 days, 1, 2, 3, and 6 months. Statistical analyses were performed using t-test, Mann-Whitney U-test, χ2 test or Fisher's exact test, and generalized estimating equations. Results: Thirty-six patients (41 eyes) were included, with 19 patients (21 eyes) in the vitrectomy group and 17 patients (20 eyes) in the non-vitrectomy group. Compared with baseline, BCVA of eyes in the vitrectomy group was significantly improved at 15 days after IDI injection, with values of 1.00 (0.52, 1.31) and 0.61 (0.30, 1.00), respectively (Z=-2.10, P=0.036); BCVA of eyes in the non-vitrectomy group was significantly improved at 1 month after IDI injection, with values of 0.76 (0.60, 1.35) and 0.52 (0.10, 0.70), respectively (Z=-2.24, P=0.025). Compared with baseline, CMT of eyes in both groups was significantly reduced at all follow-up time points after 15 days of IDI injection (all P<0.05). In the vitrectomy group, CMT before and 15 days after injection were 487 (438, 661) μm and 389 (340, 553) μm, respectively (Z=-3.45, P<0.001); in the non-vitrectomy group, CMT before and 15 days after injection were 486 (410, 641) μm and 323 (290, 396) μm, respectively (Z=-4.07, P<0.001). There were no statistically significant differences in BCVA and CMT between the two groups at all follow-up time points (all P>0.05). The time to DME recurrence was 3.0 (3.0, 4.0) months in the vitrectomy group and 5.0 (4.0, 5.0) months in the non-vitrectomy group, with no significant difference between the two groups (P=0.675). Four eyes (19.0%) in the vitrectomy group and three eyes (15.0%) in the non-vitrectomy group had high IOP, with no significant difference (P=0.529). No severe ocular or systemic complications were observed in any patients. Conclusions: IDI treatment is safe and effective in DME patients with and without prior vitrectomy, with similar efficacy, but with faster onset of action in patients with prior vitrectomy. There was no significant difference in DME recurrence within 6 months after IDI injection between the two groups.

Comparison of Innovator vs. Biosimilar Ranibizumab in Treating Diabetic Macular Edema: A Multicenter Retrospective Study.

IntroductionTo compare the efficacy of innovator ranibizumab (iRBZ—Accentrix, Novartis, India) vs. biosimilar ranibizumab (bRBZ, Razumab-Intas, India) in eyes with diabetic macular edema (DME) in an Indian population.MethodsData of patients with DME who underwent at least three injections of iRBZ or bRBZ and had a minimum of 6 months follow-up were obtained from an electronic database. Choice of injection depended upon the patient. Pro re nata (PRN) protocol from baseline was used with reinjections advised if the central macular thickness (CMT) was at least 300 μm and best corrected visual acuity (BCVA) was 20/40 or worse. Primary outcome measure was comparison of change in BCVA at 6 months between iRBZ and bRBZ.ResultsWe included 264 eyes in the iRBZ group and 69 eyes in bRBZ group, which were comparable for baseline characteristics. Mean BCVA improved from 0.64 ± 0.39 logMAR to 0.47 ± 0.31 logMAR (p < 0.001) in the iRBZ group and from 0.71 ± 0.42 logMAR to 0.50 ± 0.29 logMAR in the bRBZ group (p < 0.001) at 6 months. There were no differences in BCVA between the two groups (p > 0.05 for all time points). The CMT reduction in the iRBZ group (120 ± 196 µm) was comparable to that in the bRBZ group at 6 months (105 ± 187 µm) (p = 0.69). There was no difference in the mean number of injections taken (3.81 ± 1.2 in iRBZ vs. 3.55 ± 1.2 in bRBZ) (p > 0.05) between groups. Vision at baseline was the only factor associated with vision at last follow-up after adjusting for CMT at baseline, type of injection, and number of injections.ConclusionsBiosimilar RBZ is similar to innovator RBZ in improving vision and reducing CMT in eyes with DME in the short term.

Impact de la pandémie du SARS-CoV-2 sur l’œdème maculaire diabétique et facteurs pronostiques

ButDécrire le retentissement sur l’acuité visuelle et l’épaisseur centromaculaire après arrêt des injections intravitréennes d’anti-VEGF chez les patients diabétiques marocains au cours de la pandémie du Coronavirus. Et étudier les facteurs pouvant être associés à l’aggravation.Matériel et méthodesCette étude transversale monocentrique a inclus les patients programmés pour injections intravitréennes de Bevacizumab au cours de la période du confinement (20 mars 2020–20 mai 2020) et qui n’en ont pas bénéficié. Ont été recueillis : l’âge, le sexe, l’ancienneté du diabète, le nombre d’injections reçues avant le confinement, l’acuité visuelle en pré-confinement et post-confinement ainsi que l’épaisseur centromaculaire pré-confinement et post-confinement.RésultatsCent cinquante quatre yeux de 104 patients ont été analysés. 57,8 % étaient des hommes avec une moyenne d’âge de 59,4 ± 9,04 ans. La durée moyenne d’arrêt des injections intravitréennes est de 57,3 ± 6,7 jours. Le nombre moyen d’injections intravitréennes de Bevacizumab reçues avant le confinement a été estimé à 2,29 ± 2,1. L’aggravation de l’acuité visuelle a été notée chez 44,8 % de nos patients. Les facteurs associés à l’aggravation fonctionnelle sont le faible nombre d’injections intravitréennes de Bevacizumab reçues avant le confinement (p = 0,001) ainsi que le déséquilibre diabétique (p = 0,04). L’aggravation structurelle a été constatée chez 26,6 % des patients et elle était associée au faible nombre d’injections réalisées avant le confinement (p = 0,038).ConclusionLe report des injections intravitréennes au cours du confinement a eu des effets négatifs sur l’acuité visuelle et l’épaisseur centromaculaire des yeux avec OMD. Un report prolongé des injections intravitréennes d’anti-VEGF chez les patients diabétiques doit être évité.

Sequential applied Benzalkonium Chloride and Insulin Eye Drops Reduces Ocular Central Macular Thickness and Improves vision of Diabetics and Non-Diabetics

Introduction&#x0D; Macular Edema is a rather disabling condition that can be the consequence of several disorders of the eye. Most of the time it occurs in patients suffering from diabetic eye retinopathy. The exact pathophysiological mechanism of this condition is not clear, but it is probably the result of inflammatory processes or structural and mechanical disturbances of the vitreomacular tissue. Due to this obscure pathophysiological mechanism, a targeted efficient treatment is still lacking. However, accumulating evidence is suggesting that local application of insulin might reduce the structural and functional defects of this disorder. The aim of this study is to assess the effects of sequential applied benzalkonium chloride and Insulin eye drops on the visual acuity and central macular thickness of eyes suffering from macular edema.&#x0D; Methods&#x0D; Patients refractive to or refusing treatment with anti-VEGF agents were selected. Their visual acuity and central macular thickness were measured immediately before and until six months after treatment. The treatment consisted of twice a day application of specially prepared benzalkonium chloride and Insulin eye drops. Results are expressed as mean ± SD. The procedures followed were all in line with the guides for ethics of the hospital and were not in conflict with the declaration of Helsinki.&#x0D; Result&#x0D; After six months, the mean visual acuity increased significantly from 0.28±0.17 to 0.53±0.27 (p = 0.001) and the central macular thickness decreased from 393±122 µm to 250±72 µm (p = 0.0001).&#x0D; Conclusion&#x0D; Sequential applied benzalkonium chloride and insulin eye drops improve visual acuity and reduce central macular thickness in eyes suffering from macular edema. Further studies to elucidate the exact mechanism of action are necessary. Apart from this, the use of these drops may prove to be a cheaper and more efficient method to treat the rather disabling condition.

Intravitreal tissue plasminogen activator for treatment of vitreomacular adhesion

AIM: To evaluate the role of a single intravitreal injection of tissue plasminogen activator alone (TPA) for treatment of vitreomacular traction and the effect of combined intravitreal TPA and bevacizumab on retinal vascular diseases. METHODS: In this prospective, interventional case series a total of 24 eyes from 24 patients were studied. There were 5 eyes with symptomatic vitreomacular traction syndrome (VMT) and 19 eyes with retinal vascular diseases including diabetic macular edema (DME), diabetic vitreous hemorrhage (VH), central retinal vein occlusion (CRVO) and neovascular age related macular degeneration (AMD). Measurement of visual acuity, B-scan and OCT were performed at the baseline and 1mo after injections. Three eyes with VMT received a single intravitreal injection of 50 μg and two eyes received 100 μg TPA. Totally 19 eyes with retinal vascular diseases received combined intravitreal TPA (50 μg) and Bevacizumab (1.25 mg). RESULTS: The mean ages for retinal vascular diseases and VMT patients were 56.8y and 60.4y, respectively. Ten patients (41.7%) were male and 14 patients (58.3%) were female. 22 eyes (91.7%) were phakic and 2 eyes (8.3%) were pseudophakic. The incidence of posterior vitreous detachment (PVD) was 0% (0 of 5) and 57.8% (11 of 19) for VMT and retinal vascular diseases, respectively (P=0.04). Improvement of best corrected visual acuity (BCVA) and decrement of central macular thickness (CMT) were significantly greater in PVD positive eyes compared with PVD negative eyes. CONCLUSION: Intravitreal injection of TPA was not successful to induce complete PVD in VMT patients. Combined intravitreal injection of TPA and Bevacizumab can induce PVD and improve BCVA and decrease central macular thickness in eyes with retinal vascular diseases.

Efficacy of adjuvant topical timolol–dorzolamide with intravitreal bevacizumab injection in diabetic macular edema: A contralateral eye study

PurposeTo assess the efficacy of adjuvant topical timolol–dorzolamide with intravitreal bevacizumab (IVB) injection on anatomic and functional results in eyes affected with diabetic macular edema (DME). MethodsIn an interventional prospective contralateral pilot eye study at a third level referral academic facility, patients with bilateral DME who were treatment-naive were enrolled. Enrolled patients received a treatment plan of topical timolol–dorzolamide twice daily in the right eye. Three monthly bilateral IVB injections 1.25 mg/0.05 mL were also planned. Baseline central macular thickness (CMT) was measured by spectral-domain optical coherence tomography (SD-OCT), and clinical information such as best corrected visual acuity (BCVA) and intraocular pressure (IOP) were collected at enrollment and one month after the third injection. ResultsEleven patients (seven females) with DME were included. BCVA and CMT improved in both eyes and IOP decreased in the right eye but did not change in the left eye. In repeated measures ANOVA analysis, the decrease in CMT and improvement in BCVA were significant in the right eye. ConclusionOur study suggested that adjuvant topical timolol–dorzolamide in combination with IVB may further reduce central macular thickness in eyes with DME.

Assessment of macular function in patients with idiopathic Epiretinal membrane by multifocal Electroretinography: correlation with visual acuity and optical coherence tomography

BackgroundThis study evaluates the macular function changes in patients with idiopathic macular epiretinal membrane (ERM) by multifocal electroretinography (mfERG) and their correlations with visual acuity and central macular thickness (CMT) by optical coherence tomography (OCT).MethodsTwenty eyes of 20 patients with ERM underwent OCT and mfERG examinations. The response amplitude densities and implicit times of mfERG were compared to the control fellow eyes. Correlation analyses among visual acuity, central macular thickness and mfERG values in the central two concentric rings were performed.ResultsThe mfERG P1 response amplitude densities in ring 1–2 and P1 implicit time in ring1 were significantly changed in epiretinal membrane eyes compared with controls (P < 0.05). Multivariate stepwise linear regression analyses showed LogMAR visual acuity was significantly correlated with CMT (P = 0.004), and also with the P1 amplitude density in ring 1 (P = 0.002). CMT showed significant correlation with P1 implicit time in ring 2 (P = 0.013).ConclusionsThe mfERG abnormalities show macular function changes and correlate with visual acuity and central macular thickness in eyes with ERM. In first-order mfERG responses, P1 wave changes may be a sensitive functional measurement for ERM patients.

Retinal Vascular Caliber Changes After Topical Nepafenac Treatment for Diabetic Macular Edema

ABSTRACTPurpose: To assess changes in retinal vascular caliber in response to short-term use of nepafenac eye drops in patients with mild diabetic macular edema.Materials and methods: Thirty-four patients with previously untreated bilateral mild diabetic macular edema were included in this prospective study. For each participant, one eye was randomly assigned to nepafenac treatment (0.1%, three times/day) and the other eye was left untreated throughout the study. Using digital fundus photographs, retinal vascular calibers were calculated and compared in treated and untreated eyes at the baseline, week 1, and week 6.Results: Baseline vessel diameters did not differ in treated and fellow eyes (p > 0.05). Over the 6 weeks of the study, significant vasoconstriction of the retinal arteriolar caliber was observed at weeks 1 (p < 0.05) and 6 (p < 0.05), while an unchanged retinal venular caliber was noted between the treated and untreated eyes (p > 0.44). Significant macular thickness difference was only observed at week 6 (p = 0.002).Conclusions: Topical nepafenac has a significant narrowing effect on the retinal arteriolar diameter and a significant reductive effect on central macular thickness in eyes with mild diabetic retinopathy.

Primary (Month-6) Outcomes of the STOP-Uveitis Study: Evaluating the Safety, Tolerability, and Efficacy of Tocilizumab in Patients With Noninfectious Uveitis

To report the primary endpoint analyses of the safety and efficacy of 2 different doses of intravenous (IV) infusions of tocilizumab (TCZ), an IL-6 inhibitor, in eyes with noninfectious intermediate uveitis, posterior uveitis, or panuveitis. Randomized, controlled, multicenter clinical trial. STOP-Uveitis is a randomized, open-label safety, efficacy, and bioactivity clinical trial conducted at 5 clinical centers across the United States. The study evaluated the role of TCZ in patients with noninfectious uveitis (NIU). Thirty-seven patients with NIU were randomized into one of 2 treatment groups in a ratio of 1:1. Group 1 received IV infusions of 4mg/kg TCZ and group 2 received IV infusions of 8mg/kg TCZ. Infusions were given every 4weeks in both groups until month 6 (primary endpoint). Primary outcome measure was incidence and severity of systemic and ocular adverse events through month 6. Secondary outcome measures included mean change in visual acuity (VA), vitreous haze (VH), and central macular thickness (CMT) at month 6. A total of 37 patients were randomized in the study. At month 6, 43.5% of patients who had the potential for a 2-step decrease in VH demonstrated a 2-step decrease (40% in Group 1 and 46.1% in Group 2). Mean change in CMT was-83.88 ± 136.1μm at month 6 (-131.5 ± 41.56μm in Group 1 and-38.92 ± 13.7μm in Group 2). Mean change in VA was+8.22 ± 11.83 ETDRS letters at month 6 (10.9 ± 14.6 in Group 1 and 5.5 ± 7.8 in Group 2). Repeated infusions of TCZ were well tolerated. Repeated IV administrations of TCZ are well tolerated. TCZ (both 4 and 8mg/kg) is effective in improving VA and reducing VH and CMT in eyes with noninfectious intermediate uveitis, posterior uveitis, and panuveitis.

Changes in subfoveal choroidal thickness in diabetic macular edema

Purpose: The objective of this study is to detect the changes in subfoveal choroidal thickness (SFCT) in eyes with diabetic macular edema (DME) with the use of enhanced depth imaging optical coherence tomography (EDI-OCT). Patients and Methods: One hundred and eighty eyes were included in this prospective nonrandomized study. They were divided into three groups, each including sixty eyes; Group I with patients with DME, Group II included diabetic patients without maculopathy, and Group III were normal persons. All eyes were examined with fluorescein angiography to detect the retinopathy stage, and all eyes were examined by EDI spectral domain-OCT to measure the thickness of the choroid. Central macular thickness (CMT) and best-corrected visual acuity (BCVA) were measured in all groups to find the correlation between them and SFCT. Results: The SFCT was significantly decreased in DME group (215.12 ± 5.6 μm) compared with the other two groups (in Group II, it was 253.1 ± 9.3 μm and in Group III, it was 255.93 ± 9.2 μm) (P < 0.001). A negative correlation (r = −0.6) was detected between CMT and SFCT in patients with DME while no correlation between them was found in other two groups (in Group II, r = 0.17 and Group III, r = 0.2). A significant correlation (r = 0.5) was observed between BCVA and SFCT in Group I, while in other two groups, no correlation between the two measures was detected (in Group II, r = −0.1 and Group III, r = −0.1). Conclusion: In eyes with DME, there is a choroidal thinning on EDI OCT. There is a negative correlation between SFCT and CMT in eyes with DME.

Efficacy of One-Year Treatment with Aflibercept for Diabetic Macular Edema with Practical Protocol.

The purpose of this study was to determine the efficacy of one-year treatment of diabetic macular edema (DME) with intravitreal aflibercept (IVA) injections on a practical protocol. The medical records of 51 eyes of 43 patients who were diagnosed with DME and had received IVA treatments were reviewed. The best-corrected visual acuity (BCVA) and the central macular thickness (CMT) were measured at the baseline and at 1, 3, 6, and 12 months after the IVA. The mean number of IVA injections was 3.8 ± 2.4. The mean BCVA was significantly better and the CMT was thinner after the IVA at all follow-up times (P < 0.05). The BCVA was better in eyes with a serous retinal detachment (SRD) than without a SRD (P < 0.01). There was a significant correlation between the photoreceptor outer segment (PROS) length and BCVA at the baseline and at 12 months after the IVA (P < 0.05). A fewer number of IVA injections significantly improved the BCVA and the CMT in eyes with DME after one-year treatment. IVA was more effective in the SRD+ group than in the SRD− group. The PROS length may be a predictive marker for visual outcomes after one-year treatment with IVA for DME (IRB#2272).

Intravitreal ziv-aflibercept for macular edema following retinal vein occlusion.

AimTo report the efficacy of intravitreal ziv-aflibercept injections in eyes with macular edema due to retinal vein occlusions (RVOs).MethodsConsecutive patients with persistent or recurrent macular edema (central macula thickness >250 μm) due to RVO were enrolled in this prospective study. Study eyes received intravitreal injections of ziv-aflibercept (1.25 mg/0.05 mL) at baseline. Patients were reassessed monthly for 4 months and given additional injections pro re nata for worsening best-corrected visual acuity (BCVA), intraretinal edema or subretinal fluid seen on spectral domain optical coherence tomography, or central macular thickness (CMT) measurements >250 μm. The primary endpoint was improvement in mean CMT at 4 months. Secondary endpoints included improvement in mean BCVA, and ocular and systemic safety signals.ResultsNine eyes (five central and four branch RVOs) of nine patients were enrolled. The mean ± standard deviation CMT decreased from 604±199 μm at baseline to 319±115 μm (P=0.001) at 1 month and to 351±205 μm (P=0.026) at 4 months. The mean BCVA did not improve significantly from baseline (1.00 LogMAR) to the 1-month (0.74 LogMAR; P=0.2) and 4-month (0.71 LogMAR; P=0.13) visits. No safety signals were noted.ConclusionIn this small prospective study, intravitreal ziv-aflibercept significantly improved mean CMT in eyes with persistent or recurrent macular edema due to RVOs. Prospective, randomized trials comparing ziv-aflibercept with standard pharmacotherapy are needed to better define efficacy and safety.

Sub-foveal choroidal thickness in acute central serous chorioretinopathy and its correlation with central macular thickness

Purpose The aim of the study was to measure subfoveal choroidal thickness (SFCT) in eyes with central serous chorioretinopathy (CSCR), to compare it with that of contralateral clinically unaffected eyes and with that of other healthy persons, and to study its correlation with central macular thickness (CMT). Patients and methods Fifty-four eyes of 36 (23 male and 13 female patients) patients were included in this study under three groups: 18 eyes with recent unilateral CSCR, 18 free fellow eyes of patients with unilateral CSCR, and 18 healthy eyes of age-matched normal controls. Spectral-domain optical coherence tomography was performed to measure SFCT in all eyes and CMT in eyes with CSCR. Results The mean patient age was 37.4 years, whereas that of normal controls was 38.0 years. The mean SFCT was 332.0 μm in eyes with CSCR, 247.25 μm in the unaffected fellow eyes, and 248.74 μm in normal control eyes. SFCT in eyes with CSCR was significantly greater than that in each of the unaffected fellow eyes and normal control eyes, whereas there was no significant difference between fellow eyes and control eyes. The mean CMT in eyes with CSCR was 477.62 μm with a significant positive correlation with SFCT. Conclusion Subfoveal choroid in eyes with acute unilateral CSCR was significantly thicker than that in contralateral clinically unaffected eyes and that in healthy eyes of age-matched normal controls, whereas it was not significantly different between contralateral unaffected eyes and normal eyes. CMT was positively correlated with SFCT in eyes with CSCR.

Evaluation of the dual staining technique for complete removal of idiopathic epimacular membranes

Purpose This study tries to evaluate the usefulness of the dual staining first with Triamcinolone acetonide (TA) to effectively visualize and remove the fibrous component of idiopathic epimacular membrane (EMM) and then with brilliant blue G (BBG) to selectively remove the internal limiting membrane (ILM). The primary outcome was the visual acuity improvement and the concomitant decrease in the central macular thickness (CMT) after surgery, and the secondary outcome was the condition of the ILM after this dual staining. Subjects and Methods A prospective, non-randomized, observational cohort study including 15 eyes .The inclusion criterion was a clinically detectable idiopathic EMM diagnosed by fundus examination or optical coherence tomography (OCT), causing a decrease of visual acuity. The exclusion criteria included prior intravitreal injection of TA or antivascular endothelial growth factor, ocular inflammation or prior trauma. During a standard 23 G vitrectomy, peeling the EMM was carried out after administration of TA, BBG (0.25 mg /mL) was injected onto the retinal surface utilizing the ''dry method'' or the ''air-filled technique''. Both stains will be completely washed out immediately. Then the surgeon recorded the characteristics of the underlying ILM before peeling. Postoperatively the patients were followed up at 1 day, 1 week, 1 month and at 6 months. Primary and secondary outcomes were recorded. Results Our patients included 8 (53.3%) females and 7 males (46.7%). A single surgeon performed all surgeries. TA was used to identify the posterior hyaloid in all 14 cases (93.3%) with no prior vitreous surgery and to effectively visualize and remove the idiopathic EMM in all 15 cases. Three (20%) of the cases had EMM remnants after BBG staining. When this dye was used to stain the ILM during surgery, the unstained EMM clearly stood out against the ILM, which was stained blue. After EMM peeling, all of the eyes had residual ILM except one (6.3%). In all eyes, the surgeon was unable to determine the status of the ILM before BBG staining. The ILM was present and damaged in 8 eyes (53.3%), while it was present and undamaged in 6 (40%). The mean preoperative CMT in eyes were the ILM was found to be damaged on table was 565.3 ± 79.9 μm, while the mean preoperative CMT in eyes were the ILM was undamaged was 446.6 ± 34.4 microns, this was statistically significant (P = 0.005). At 6 months, decimal BCVA improved from 0.18 ± 0.06 at baseline to 0.53 ± 0.11 (P = 0.005). Again at 6 months, the CMT also improved from 506.2 ± 90.03 ΅m at baseline to 365.8 ± 53.3 μm (P Conclusions In conclusion, dual staining starting with TA effectively led to adequate visualization and removal of the posterior hyaloid as well as the fibrous component of the idiopathic EMM. The subsequent BBG administration in an air filled vitreous (the dry technique) helped selective removal of the ILM with no deleterious effects on the functional or the anatomical outcomes of the procedure as demonstrated by the significant improvement in both the BCVA and the CMT 6 months after surgery.

Follow‐up of IOP and central macular thickness after repeated dexamethasone implants in retinal vein occlusion, about 29 cases

AbstractPurpose To investigate the impact of intravitreal dexamethasone implant (ozurdex) on intraocular pressure and on central macular thickness in eyes with macular oedema secondary to retinal vein occlusion.Methods Twenty‐nine patients diagnosed with macular oedema due to retinal vein occlusion (11/29 branch RVO‐18/29 central RVO) and treated with Ozurdex were enrolled in this prospective uncontrolled study. Patients were followed up at 1, 2, 3, 4 and 6 months for IOP (air pulsed tonometer) and central macular thickness (CMT, spectralis SD‐OCT).Results The mean ozurdex injections was 2,4 (1‐5). Most of the patients increased their IOP less than 6mmHg from baseline and were considered as low responder. 27% of patients were « medium responder » and increased their IOP from +6 to 15 mmHg. Only one was a high responder (+19mmHg). OHT occurred during the first (12,5%) or the second month (24%). Two patients has developed OHT only at the second injection (24mmHg). thirty‐one % of patients need a topical hypotensive therapy. The mean initial CMT was 579 μm (+/‐162μm). The mean CMT reduction between M0 and M2 was 282 μm +/‐204μm for the first injection. The anatomic effect was reproducible for the second and the third ozurdex but decreased at the fourth injection (‐196μm). Only two patients had a chronic retinal oedema after two injections.Conclusion OHT has been observed in some patients since M1, so visit at M1 and M2 must be keept to check this point for the first injection. We confirm that very few new patients present OHT during the following injections. Repeated injections of ozurdex provide an effective reduction of the CMT for at least the first three injections. Only one patient was suspected of tachyphylaxis.

External limiting membrane as a predictor of visual improvement in diabetic macular edema after pars plana vitrectomy

To evaluate the predictors of visual improvement using spectral-domain optical coherence tomography (SD-OCT) in eyes with resistant diabetic macular edema (DME) treated with pars plana vitrectomy. Thirty-four eyes with resistant DME were evaluated in a retrospective manner. Several SD-OCT variables including photoreceptor inner segment/outer segment (IS/OS) junction, external limiting membrane (ELM) integrity, and central macular thickness (CMT) before and after the surgery, were evaluated by two experienced observers, masked to visual acuity. The visual improvement was used as the outcome measure for a stepwise regression, while the OCT factors were used as predictors. The strongest predictor of vision improvement was pre-operative damage to the ELM (p = 0.0277) compared to IS/OS junction (p = 0.03). Pretreatment central macular thickness was a very weak predictor (p = 0.18) of visual improvement. For each percentage increase of ELM integrity there was a 0.13 letter gain in vision. ELM integrity explained 16% of the visual acuity improvement after treatment, which rose to 21% with the addition of CMT. The addition of IS/OS junction in the model did not add predictive information. Evaluation of ELM preoperatively predicts the vision improvement more accurately than the IS/OS junction and CMT in eyes with DME.

Single intravitreal bevacizumab injection effects on contrast sensitivity in macular edema from branch retinal vein occlusion

To evaluate the effect of a single intravitreal bevacizumab injection on visual acuity, contrast sensitivity and optical coherence tomography-measured central macular thickness in eyes with macular edema from branch retinal vein occlusion. Seventeen eyes of 17 patients with macular edema from unilateral branch retinal vein occlusion were treated with a single bevacizumab injection. Patients were submitted to a complete evaluation including best corrected visual acuity, contrast sensitivity and optical coherence tomography measurements before treatment and one and three months after injection. Visual acuity, contrast sensitivity and optical coherence tomography measurements were compared to baseline values. Mean visual acuity measurement improved from 0.77 logMAR at baseline to 0.613 logMAR one month after injection (P=0.0001) but worsened to 0.75 logMAR after three months. Contrast sensitivity test demonstrated significant improvement at spatial frequencies of 3, 6, 12 and 18 cycles/degree one month after injection and at the spatial frequency of 12 cycles/degree three months after treatment. Mean ± standard deviation baseline central macular thickness (552 ± 150 µm) reduced significantly one month (322 ± 127 µm, P=0.0001) and three months (439 ± 179 µm, P=0.01) after treatment. Bevacizumab injection improves visual acuity and contrast sensitivity and reduces central macular thickness one month after treatment. Visual acuity returns to baseline levels at the 3-month follow-up, but some beneficial effect of the treatment is still present at that time, as evidenced by optical coherence tomography-measured central macular thickness and contrast sensitivity measurements.

EARLY CHANGE OF CENTRAL MACULAR THICKNESS AFTER INTRAVITREOUS TRIAMCINOLONE OR BEVACIZUMAB IN DIABETIC MACULAR EDEMA OR RETINAL VEIN OCCLUSION

To evaluate the immediate changes after intravitreous triamcinolone acetonide or intravitreous bevacizumab in diabetic macular edema (DME). A nonrandomized interventional study. Type 2 diabetic patients were included. Intravitreous triamcinolone acetonide (4 mg) was injected for 22 eyes with DME and IVB (1.25 mg) for 18 eyes with DME. The early time-dependent changes of central macular thickness were evaluated by optical coherence tomography before and from 1 hour to 1 month after intervention. Intravitreous bevacizumab was also tested in patients with retinal vein occlusion as a control of non-DME. Visual acuity was also examined. Compared with the baseline, central macular thickness of eyes with DME decreased significantly 1 hour after intravitreous triamcinolone acetonide (P < 0.05, Wilcoxon signed rank test), while it did not significantly until 24 hours after IVB. The decrease in central macular thickness was observed significantly from 3 hours after IVB in retinal vein occlusion (P < 0.05, Wilcoxon signed rank test), and it was more evident in retinal vein occlusion than DME after IVB. Visual acuity improved significantly in DME with intravitreous triamcinolone acetonide or IVB at 1 month (P < 0.01 and P < 0.05, respectively, Wilcoxon signed rank test). Factors responsive to triamcinolone acetonide, other than vascular endothelial growth factor, might play an important role in pathogenesis of DME compared with retinal vein occlusion. Although no conclusion can be drawn, immediate decrease in central macular thickness after intravitreous triamcinolone acetonide might indicate the possible involvement of a nongenomic pathway of triamcinolone acetonide action.

Intravitreal bevacizumab for refractory choroidal neovascularization (CNV) secondary to uveitis

To assess the short-term efficacy and safety of intravitreal bevacizumab injections (IVB) for refractory choroidal neovascularization (CNV) secondary to uveitis. Ten patients affected by choroidal neovascularization secondary to uveitis unresponsive to immunosuppression associated or not with photodynamic therapy (PDT) were consecutively included. All patients underwent a complete ophthalmic examination including best-corrected visual acuity (BCVA), fluorescein (FA) and indocyanine green angiographies (ICG), optical coherence tomography (OCT) at baseline, and after IVB injection (1.25 mg/0.05 ml). CNV was subfoveal in eight cases and juxtafoveal in two cases. Mean follow-up was 7.5 months. After treatment, the logMAR BCVA improved from 0.62 +/- 0.4 (Snellen equivalent of 20/55) to 0.45 +/- 0.35 (Snellen equivalent of 20/40) at 1 month (p = 0.01), then remained stable during the follow-up. Mean central macular thickness (CMT) was reduced from 326 +/- 95 microm before treatment to 267 +/- 28 microm (p = 0.03) at last visit. Mean number of IVB was 2.5. Leakage from inflammatory CNV was stopped in three eyes and decreased in seven eyes. No systemic or ocular adverse events were recorded. Intravitreal bevacizumab improves BCVA and reduces central macular thickness in eyes with inflammatory CNV refractory to immunosuppression associated or not with PDT. Further study is necessary to assess the efficacy and safety in the long term.

The correlation between optical coherence tomographic features and severity of retinopathy, macular thickness and visual acuity in diabetic macular edema

To investigate the correlation between the features of optical coherence tomography (OCT) and the severity of concurrent retinopathy, central macular thickness (CMT), and best-corrected visual acuity in clinically significant diabetic macular edema. In a prospective study, OCT was performed in 55 eyes of 55 patients with clinically significant diabetic macular edema, in 58 eyes of 30 patients with diabetes without retinopathy, and in 40 eyes of 21 healthy control subjects. The OCT features were categorized into: type 1, sponge-like retinal swelling; type 2, cystoid macular edema; type 3, serous retinal detachment; and type 4, vitreofoveal traction. The CMT in eyes with diabetic macular edema was significantly higher than in eyes of healthy controls or in eyes of diabetic patients without retinopathy (P < 0.001). Visual acuity correlated with CMT in diabetic macular edema (r = 0.558, P < 0.001). The prevalence of OCT type 1 was significantly higher in eyes with mild-to-moderate non-proliferative retinopathy (NPDR) than in eyes with severe NPDR to proliferative retinopathy (PDR) (P = 0.0069). The prevalence of OCT types 3 and 4 was significantly higher in eyes with severe NPDR to PDR than in eyes with mild-to-moderate NPDR (P = 0.0056). OCT type 1 showed the least CMT (P < 0.001) and the best visual acuity (P = 0.002). There was a significant correlation between OCT patterns of clinically significant diabetic macular edema and severity of retinopathy, CMT, and visual acuity.