Central Macular Thickness In Group Research Articles

Safety and efficacy profile of intravitreal ranibizumab vs dexamethasone in treatment of naïve diabetic macular edema.

To compare the safety and efficacy parameters of intravitreal ranibizumab vs intravitreal dexamethasone (IVD) in the treatment of patients with naïve diabetic macular edema (DME) in terms of best-corrected visual acuity (BCVA), central macular thickness (CMT), and possible complications like intraocular pressure (IOP) rise and cataract progression. A hospital-based prospective and comparative study of naïve DME patients was conducted between November 2020 and October 2021 with a minimum follow-up (F/U) period of 6 months. Thirty phakic patients received one dose of IVD implant (Group A) and the other 30 (Group B) received three consecutive monthly doses of ranibizumab. The main exclusion criteria were steroid responders and the presence of ocular inflammation. The mean pre-injection CMT in Group A was 405µ and reduced to 297.07µ at 3 months and 278.35µ at 6 months. Mean increase in logMAR BCVA was 0.55. The mean pre-injection IOP was 16.28 and 17.64 mm of Hg at 6 months. In Group B, the mean pre-injection CMT was 401.07µ and reduced to 276.1µ at 3 months and 292.9µ at 6 months. Mean BCVA increased to 0.37. The mean pre-injection IOP was 17.28 mm Hg and 16.42 mm Hg at 6 months. There was no significant progression of cataract in both groups. The mean decrease in CMT was comparable in both the groups at 6 months F/U with an improvement of BCVA with no significant IOP fluctuation or cataract progression. Hence, IVD appears to be noninferior to ranibizumab in the treatment of naïve DME.

Long-term choroidal thickness changes based on the subtype of macular neovascularization in neovascular age-related macular degeneration (5-year follow-up).

To evaluate the long-term choroidal thickness changes in combination with other morphological and functional outcomes during anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (nAMD) based on the subtype of macular neovascularization (MNV): MNV-1 (within the subretinal pigment epithelium space) and MNV-2 (within the subretinal space). This retrospective study included 58 eyes from 53 patients with naïve nAMD who received anti-VEGF therapy over a 60-month period. All eyes were treated initially with intravitreal bevacizumab following Pro re nata regimen. Main outcome measures included the following: subfoveal choroidal thickness (SFCT), best corrected visual acuity (BCVA), central macular thickness (CMT), development of subfoveal geographic atrophy (GA), and the number of injections. Thirty-four eyes had MNV-1 (group 1) and 24 eyes had MNV-2 (group 2). SFCT in group 1 vs group 2 was (210 ± 45µm vs 191 ± 52µm, p = 0.01) before treatment and (170 ± 47µm vs 179 ± 48µm, p = 0.24) after 60months. BCVA (log MAR) in group 1 vs group 2 was (0.57 ± 0.18 vs 0.53 ± 0.22, p = 0.47) before treatment and (0.59 ± 0.23 vs 0.69 ± 0.16, p = 0.04) after 60months. CMT in group 1 vs group 2 was (398 ± 154µm vs 382 ± 103µm, p = 0.86) before treatment and (297 ± 68µm vs 283 ± 67µm, p = 0.14) after 60months. The number of injections per eye over a period of 60months was significantly higher in group 1 (34.9 ± 11 vs 29.0 ± 14, p = 0.04). The proportion of eyes with subfoveal GA after 60months was significantly higher in group 2 (13 eyes, 54%) than in group 1 (9 eyes, 25%) (p = 0.03). Over the full 60months of anti-VEGF treatment, eyes with MNV-1 showed a greater reduction in choroidal thickness, better visual acuity, and less development of subfoveal geographic atrophy compared with eyes with MNV-2. The significantly thicker choroid in eyes with MNV type 1 at baseline seems to have a positive impact on long-term outcomes.

Comparison of Long-term Efficacy of Intravitreal Ranibizumab in Diabetic Retinopathy following Monthly vs Pro Re Nata vs Treat and Extend Protocol

Introduction: Diabetic Retinopathy (DR) is a major complication of Diabetes Mellitus (DM), which remains a leading cause of visual loss in working age populations. The most common cause of vision loss in patients with DR is Diabetic Macular Oedema (DME). Intravitreal administration of anti-Anti-Vascular Endothelial Growth Factor (anti-VEGF) agents is currently the mainstay of therapy for both early and advanced stages of DR. Aim: To compare long-term change in Central Macular Thickness (CMT) and Best Corrected Visual Acuity (BCVA) in patients with Non Proliferative Diabetic Retinopathy (NPDR) with Clinically Significant Macular Oedema (CSME) after receiving Intravitreal Ranibizumab (IVR) following monthly, Pro Re Nata (PRN) protocol and TreaT&Extend (T&E) protocol. Materials and Methods: This is a hospital based longitudinal prospective cohort study conducted on patients attending the Out Patient Department (OPD) of the Opthalmology Department at Midnapore Medical College & Hospital West Bengal, India. from October 2018 to February 2021. Institutional Ethical clearance was obtained prior to the initiation of the study. Among 93 patients, 31 were chosen each for IVR PRN Monthly (Group A), (Group B) and T&E protocol (Group C) over a period of nine months. CMT and BCVA were measured at baseline and followed up monthly for 12 months after last injection using Spectral Domain Optical Coherence Tomography (SD-OCT), while Glycated Haemoglobin (HbA1c) level was maintained below 7.4. Statistical analyses were performed using Statistical Package of Social Sciences (SPSS) statistics version 20 software. Chi-square test was used to find out the association between categorical variables. Pre and post comparisions were done using Wilcoxon sign rank test. A p-value less than 0.05 were considered as statistically significant. Results: There was significant decrease in CMT and betterment of BCVA in all groups at the end of treatment compared to baseline. At six months and one year of last injection there was no significant change in CMT in group A and C while group B at one year (p=0.0487) showed significant increase. There was no significant worsening of BCVA in group A and group C while group B (p=0.01) showed significant worsening at one year longterm follow-up. Conclusion: Thus, the present study concludes that, even though monthly protocol T&E protocol are equally good compared to PRN protocol on the basis of long-term beneficial effect, T&E protocol needed comparatively fewer doses of IVR compared to monthly protocol making it the choice of protocol for long-term control in NPDR with DME patients.

Intravitreal aflibercept following treat and extend protocol versus fixed protocol for treatment of neovascular age-related macular degeneration

BackgroundTo assess the morphological and functional outcome of intravitreal aflibercept following the treat and extend protocol compared to the fixed protocol for treatment of eyes with neovascular age-related macular degeneration.MethodsThis retrospective study included 126 eyes of 113 patients with primary onset neovascular age-related macular degeneration who were followed for 12 months. All eyes were treated with 2 mg/0.05 mL aflibercept. All eyes received an upload with three monthly aflibercept injections. We subsequently studied two groups of eyes. For group 1, 54 eyes were treated following the treat and extend protocol. For group 2, 72 eyes were treated following the fixed protocol (fixed 2-monthly interval). Main outcome measures included: best corrected visual acuity (BCVA), central macular thickness (CMT) and number of injections.ResultsBCVA (logMAR) in group 1 vs group 2 was (0.61 ± 0.3 vs 0.72 ± 0.3, p = 0.09) before treatment and (0.48 ± 0.3 vs 0.51 ± 0.3, p = 0.6) after one year of treatment. CMT in group 1 vs group 2 was (371 ± 101 μm vs 393 ± 116 μm, p = 0.5) before treatment and (284 ± 60 μm vs 290 ± 67 μm, p = 0.1) after one year of treatment. Number of injections/eye in group 1 vs group 2 was (8.5 ± 2.2 vs 7.0 ± 0, p < 0.001).ConclusionsSignificant differences regarding BCVA and central macular thickness were not found between both treatment protocols during the first year of treatment using aflibercept. However, a significantly higher number of injections was needed for eyes in the treat and extend group during the first year of treatment. This might suggest that aflibercept should better not be extended past an 8 weeks interval during the first year of treatment.Study registrationThis study was approved by the Ethics Committee of the Medical Association of Saarland, Germany (Nr. 123/20, Date: 16.06.2020). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Retinal changes after uncomplicated phacoemulsification in diabetic patients

Aim To detect the incidence and progression of diabetic retinopathy (DR) and macular edema following uncomplicated phacoemulsification in cataractous diabetic patient. Patients and methods A prospective randomized interventional study was performed at Al-Zahraa Hospital, during the period from April 2017 to December 2018. Informed written consent was taken from each participant in the study. A total of 60 eyes of 30 cataractous diabetic patients with type II diabetes were classified into two groups: group A included 30 cataractous eyes that underwent uncomplicated phacoemulsification surgeries with posterior chamber foldable intraocular lens implantation, and group B included contralateral nonoperated 30 eyes of the same patients. Results There was a statistically significant increase of mean postoperative central macular thickness (CMT) at 1, 3, and 6 months in comparison with mean preoperative CMT in group A (P&lt;0.05). It was 223.43±15.95 preoperatively. At all duration of follow-up, the mean CMT in group A was more than that in group B, with a statistically significant difference (P&gt;0.05). Conclusion Phacoemulsification surgery most probably does not cause acceleration of DR in patients having no DR or mild DR and no maculopathy preoperatively.

Idiopathic epiretinal membrane removal with and without internal limiting membrane peeling: a prospective comparative study

Aim This is a prospective comparative study of the macular morphology and visual outcome after epiretinal membrane (ERM) removal with and without internal limiting membrane (ILM) peeling in cases of idiopathic ERM. The study was carried out in the Research Institute of Ophthalmology, Giza, Egypt from February 2015 to February 2017.Patients and methods A total of 40 eyes of 40 patients with visually significant idiopathic ERM were included in the study. A standard three-port 23-gauge pars plana vitrectomy (PPV) was conducted in all patients. Twenty eyes (Group A) were subjected to ERM removal only, while ILM peeling with ERM removal was performed in the other 20 eyes (Group B). Central macular thickness (CMT) and foveal contour on optical coherence tomography (OCT) in addition to best-corrected visual acuity (BCVA) were obtained at baseline and at 1, 3, 6 and 12months postoperatively.Results The mean BCVA significantly improved in both groups, with no statistically significant difference between the two groups at 12 months postoperatively (P=0.053). The mean preoperative and postoperative BCVA were 0.19 and 0.50 decimal units, respectively, in group A, while in group B, the mean preoperative and postoperative BCVA were 0.13 and 0.44 decimal units, respectively. Despite a statistically significant more reduction of CMT in group A compared with group B at 1 month postoperatively (324.80 and 403.95 µm, respectively, P=0.01), no statistically significant difference was found between the two groups at 12 months postoperatively (277.40 and 306.20 µm, respectively). Normal foveal contour was achieved in 13 (65%) and 6 (30%) eyes in groups A and B, respectively.Conclusion Anatomical and functional improvements could be achieved in both groups, with no statistically significant difference at 12 months postoperatively. Adding ILM peeling to idiopathic ERM removal did not appear to improve the outcome in this cohort. Therefore, ILM should not be routinely peeled as safety remains controversial.

PERIPHERAL ISCHEMIC RETINAL PHOTOCOAGULATION IN ADDITION TO INTRAVITREAL BEVACIZUMAB VERSUS INTRAVITREAL BEVACIZUMAB ALONE FOR THE TREATMENT OF MACULAR EDEMA SECONDARY TO CENTRAL RETINAL VEIN OCCLUSION: A Randomized Double-Masked Controlled Clinical Trial.

To investigate the effects of peripheral ischemic retinal photocoagulation in addition to intravitreal bevacizumab (IVB) in the treatment of macular edema due to ischemic central retinal vein occlusion. Forty-eight eyes of 48 treatment-naive patients were randomly selected and divided into 2 groups. Group A comprised 24 eyes that were treated with three consecutive monthly injections of IVB, and Group B comprised 24 eyes that were treated with IVB plus photocoagulation of the peripheral nonperfused retina. Further IVB injections were administered as needed in both groups. Monthly follow-up was conducted for 9 months after the first injection. The data of 46 patients were analyzed. Best-corrected visual acuity changes from the fourth to eighth month follow-up in comparison with the baseline were significantly higher in Group B (P = 0.002-0.044-0.002-0.002-0.012). In addition, significant differences were observed in central macular thickness in Group B throughout the study period (all P < 0.001). Group B required less frequent IVB injections during the 9-month study period. Photocoagulation of the retinal nonperfused area in patients with macular edema because of central retinal vein occlusion might amplify the beneficial effects of IVB on best-corrected visual acuity and central macular thickness and reduce the frequency of IVB injection.

Effect of Uncomplicated Cataract Surgery on Central Macular Thickness in Diabetic and Non-diabetic Subjects.

PurposeTo assess the quantitative changes of macula in diabetic and non-diabetic eyes after uncomplicated cataract surgery.MethodsIn this prospective interventional study being performed in a tertiary healthcare hospital, a total of 660 eyes were divided into two groups. Group 1 included 330 eyes from healthy subjects and group 2 included 330 eyes from well-controlled diabetic subjects with no diabetic retinopathy planned for phacoemulsification with foldable IOL implantation by the same surgeon under similar settings. Optical Coherence Tomography (Heidelberg Spectralis SD-OCT) was used to assess preoperative and postoperative central macular thickness (CMT) at weeks 1 and 6.ResultsThe mean CMT in group 1 preoperatively, at postoperative week 1, and at post-operative week 6 was 257.03 20.904, 262.82 17.010, and 265.15 20.078 µm, respectively. The corresponding values in group 2 were 255.36 17.852, 259.15 16.644, and 266.09 18.844 µm, respectively. There was no significant difference in the mean CMT values between the two groups on any of the three occasions when the CMT was measured (P = 0.374 and P = 0.313 at weeks 1 and 6, respectively).Conclusion There was no statistically significant difference in CMT between normal subjects and diabetic subjects without diabetic retinopathy preoperatively and in early postoperative period after uncomplicated phacoemulsification surgery.

Optical Coherence Tomography Patterns in Diabetic Macular Edema and Its Impact on Anatomical and Functional Outcome after Intravitreal Injection of Ranibizumab

Background: to report the anatomical and functional outcome based on patterns of optical coherence tomography (OCT) morphology in diabetic macular edema (DME), following treatment with intravitreal ranibizumab (IVR) injection. Aim of the Work: to evaluate the role of OCT in detecting the patterns of DME and its effect on anatomical and functional outcome after IVR injection. Patients and Methods: this study enrolled 30 eyes of patients with DME. These patients were categorized into 3 groups according to OCT finding, group I- 10 eyes with diffuse retinal thickening (DRT), group II- 10 eyes with cystoid macular edema (CME), group III- 01 eyes with neurosensory detachment (NSD). All patients received a three monthly doses of intravitreal ranibizumab. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed before and after the treatment (in the 1st, 3rd and 6th month). Results: at month 6, mean BCVA changed with 0.24 ± 0.057 Decimal (P<0.001),0.23± 0.10 Decimal (P<0.001) and 0.11 ± 0.12 Decimal (P=0.019), respectively, for DRT, CME and NSD groups. Mean CMT decreased by119.80 ± 84.58μm (P=0.002) in DRT group, by83.00 ± 65.98μm (P=0.003) in CME group and by 102.30 ± 110.25 μm (P=0.017) in NSD group. The DRT group was associated with superior BCVA improvement and greater reduction in CMT. Conclusion: we found statistically significant improvement of BCVA and CMT in all groups of DME based on OCT pattern at final follow-up with greater reduction in CMT and superior BCVA improvement in DRT group.

Optical Coherence Tomography Patterns in Diabetic Macular Edema and Its Impact on Anatomical and Functional Outcome after Intravitreal Injection of Ranibizumab

Background: to report the anatomical and functional outcome based on patterns of optical coherence tomography (OCT) morphology in diabetic macular edema (DME), following treatment with intravitreal ranibizumab (IVR) injection. Aim of the Work: to evaluate the role of OCT in detecting the patterns of DME and its effect on anatomical and functional outcome after IVR injection. Patients and Methods: this study enrolled 30 eyes of patients with DME. These patients were categorized into 3 groups according to OCT finding, group I- 10 eyes with diffuse retinal thickening (DRT), group II- 10 eyes with cystoid macular edema (CME), group III- 01 eyes with neurosensory detachment (NSD). All patients received a three monthly doses of intravitreal ranibizumab. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed before and after the treatment (in the 1st, 3rd and 6th month). Results: at month 6, mean BCVA changed with 0.24 ± 0.057 Decimal (P<0.001),0.23± 0.10 Decimal (P<0.001) and 0.11 ± 0.12 Decimal (P=0.019), respectively, for DRT, CME and NSD groups. Mean CMT decreased by119.80 ± 84.58μm (P=0.002) in DRT group, by83.00 ± 65.98μm (P=0.003) in CME group and by 102.30 ± 110.25 μm (P=0.017) in NSD group. The DRT group was associated with superior BCVA improvement and greater reduction in CMT. Conclusion: we found statistically significant improvement of BCVA and CMT in all groups of DME based on OCT pattern at final follow-up with greater reduction in CMT and superior BCVA improvement in DRT group.

Intravitreal ranibizumab versus aflibercept following treat and extend protocol for neovascular age-related macular degeneration.

To assess the morphological and functional outcome and stability of the "treat and extend" protocol using aflibercept compared to ranibizumab for the treatment of eyes with neovascular age-related macular degeneration. This retrospective study included 100 eyes of 94 patients with primary onset neovascular age-related macular degeneration followed up for 12months. We studied two groups of eyes: group 1, 50 eyes treated with 0.5mg/0.05mL ranibizumab and group 2, 50 eyes treated with 2.0mg/0.05mL aflibercept. During the first year, all eyes received 3 aflibercept or ranibizumab injections monthly as upload phase. Then, eyes were treated with a treat and extend algorithm. Main outcome measures included: best corrected visual acuity (BCVA), central macular thickness (CMT), and the number of injections. In addition, we compared recurrence rates between the two groups. BCVA (log MAR) in group 1 vs group 2 was 0.54 ± 0.31 vs 0.49 ± 0.30 (p = 0.38) before treatment and 0.49 ± 0.33 vs 0.47 ± 0.32 (p = 0.85) after treatment. The visual improvement (decimal) was 0.05 ± 0.13 vs 0.04 ± 0.12 (p = 0.91). CMT in group 1 vs group 2 was 375.6 ± 98.3μm vs 369.6 ± 103.7μm (p = 0.73) before treatment and 306.3 ± 71.8μm vs 294.8 ± 96μm (p = 0.54) after treatment. The decrease in CMT was 69.3 ± 93μm vs 74.8 ± 96μm (p = 0.77). The number of injections/eye after upload phase in group 1 vs group 2 was 5.88 ± 1.4 vs 6.16 ± 1.3 (p = 0.25). Finally, major recurrence rates were statistically significantly different between the two groups (2% vs 6%, p = 0.04). Significant differences regarding BCVA, central macular thickness, and the number of injections were not found between aflibercept and ranibizumab during the first year following the treat and extend protocol. However, the significantly higher major recurrence rates in the aflibercept group after extending the treatment interval to 10weeks might suggest that aflibercept should better not to be used in longer than 8weeks intervals during the first year of treatment.

Choroidal Thickness in Patients with Diabetic Macular Edema and its Correlation to Macular Thickness and Vision

Purpose: To investigate the relationship between subfoveal choroidal thickness, central macular thickness, visual acuity and the presence of diabetic macular edema (DME) using spectral domain optical coherence tomography (SD-OCT). Methods:A prospective, nonrandomized case control study of 124 eyes was included in the study and divided into three groups: Group I: 56 eyes having NPDR without macular edema, Group II: 27 eyes having NPDR with DME, Group III: 41 eyes of normal healthy subjects. Central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were measured on the OCT images and statistically compared. Pearson correlation analysis used to evaluate the relationships between choroidal thickness, macular thickness and visual acuity. Results: A total of 124 eyes of 76 patients; mean age 52.56 ±8.91years were included in the study. Mean bestcorrected visual acuity LogMAR was better in the control group (0.20 ± 0.40) than diabetic groups (0.42 ± 0.40 in group I, 0.80 ± 0.45 in group II) and the difference was significant among the groups (P= 0.01). Mean CMT was thicker in DME group (374.63μm ± 105.43) than the other 2 groups (246.66± 24.85 μm in group I, 227.05 μm ± 21.97 in group III) and the difference was significant among the groups (P= 0.00). Mean SFCT was thinner in DME group (234.93 μm ± 42.68) than d the other 2 groups (246.41 μm ± 44.37 in group I, 250.20 μm ± 53.10 in group III) but the difference was not statistically significant (P= 0.41). A significant correlation was found between LogMAR and CMT in group II (r=0.391, P=0.044) indicating that the vision may decrease as the central macular thickness increases in diabetic groups. A weak inverse correlation was found between LogMAR and SFCT in all groups indicating that the vision may decrease as the choroidal thickness decrease. A weak negative correlation was found between CMT and SFCT in diabetic groups (r=-0.142 in group I, r=-0.152 in group II) indicating that the choroidal thickness may decrease as the central retinal thickness increases in diabetic groups. Conclusion: In diabetic eyes, there is an overall thinning of the choroid. SFCT is directly related to vision and macular thickness.

Choroidal Thickness in Patients with Diabetic Macular Edema and its Correlation to Macular Thickness and Vision

Purpose: To investigate the relationship between subfoveal choroidal thickness, central macular thickness, visual acuity and the presence of diabetic macular edema (DME) using spectral domain optical coherence tomography (SD-OCT). Methods:A prospective, nonrandomized case control study of 124 eyes was included in the study and divided into three groups: Group I: 56 eyes having NPDR without macular edema, Group II: 27 eyes having NPDR with DME, Group III: 41 eyes of normal healthy subjects. Central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were measured on the OCT images and statistically compared. Pearson correlation analysis used to evaluate the relationships between choroidal thickness, macular thickness and visual acuity. Results: A total of 124 eyes of 76 patients; mean age 52.56 ±8.91years were included in the study. Mean bestcorrected visual acuity LogMAR was better in the control group (0.20 ± 0.40) than diabetic groups (0.42 ± 0.40 in group I, 0.80 ± 0.45 in group II) and the difference was significant among the groups (P= 0.01). Mean CMT was thicker in DME group (374.63μm ± 105.43) than the other 2 groups (246.66± 24.85 μm in group I, 227.05 μm ± 21.97 in group III) and the difference was significant among the groups (P= 0.00). Mean SFCT was thinner in DME group (234.93 μm ± 42.68) than d the other 2 groups (246.41 μm ± 44.37 in group I, 250.20 μm ± 53.10 in group III) but the difference was not statistically significant (P= 0.41). A significant correlation was found between LogMAR and CMT in group II (r=0.391, P=0.044) indicating that the vision may decrease as the central macular thickness increases in diabetic groups. A weak inverse correlation was found between LogMAR and SFCT in all groups indicating that the vision may decrease as the choroidal thickness decrease. A weak negative correlation was found between CMT and SFCT in diabetic groups (r=-0.142 in group I, r=-0.152 in group II) indicating that the choroidal thickness may decrease as the central retinal thickness increases in diabetic groups. Conclusion: In diabetic eyes, there is an overall thinning of the choroid. SFCT is directly related to vision and macular thickness.

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.

Comparison between multispot laser and conventional laser in the treatment of diabetic clinically significant macular edema

Objectives The purpose of this study was to assess the safety and efficacy of multispot laser and conventional laser in the treatment of nonproliferative diabetic retinopathy with clinically significant macular oedema (CSME) in relation to the visual outcome, central macular thickness (CMT) using optical coherence tomography, and presence of adverse events. Patients and methods This prospective randomized study included a total of 50 eyes from the research institute of ophthalmology in 2015 that were divided into two groups of 25 patients each. Group A patients underwent focal or modified grid macular laser photocoagulation using green laser 532 nm. Group B patients underwent focal or modified grid macular laser photocoagulation using multispot laser photocoagulation Valon TT. Inclusion criteria were as follows: type II diabetes and clinically significant macular edema. Best-corrected visual acuity (BCVA), optical coherence tomography readings, intraocular pressure (IOP), and adverse events were recorded preoperatively and at 1 week, 1 month, and 3 months postoperatively. Results The mean preoperative BCVA in conventional laser was 0.294 ± 0.17 decimal and that in multispot laser was 0.30 ± 0.21. The mean BCVA 3 months after laser in group A was 0.4820 ± 0.244 decimal (P = 0.001) and that in group B was 0.50 ± 0.20 (P = 0.001). The mean preoperative CMT in group A was 375.92 ± 65.69 μm and that in group B was 361.0 ± 50.400 μm. The mean CMT 3 months after laser in group A was 314.44 ± 85.94 μm (P = 0.001) um and that in group B was 0322.67 ± 57.50 μm (P = 0.001). The multispot system parameters used a higher power of 155 ± 90.1 mW (P = 0.001) compared with the conventional laser to produce the same therapeutic visible effect. Conclusion Multispot system was safe, rapid, and effective in the treatment of clinically significant macular edema in short-term follow-up periods and had a short exposure time. Although the short pulse duration of the multispot system necessitated the use of a higher power, it was not associated with adverse effects.

Clinical efficacy of intravitreal conbercept injection and macular grid pattern photocoagulation in treating macular edema secondary to non-ischemic branch retinal vein oclussion

Objective To study and compare the clinical efficacy between intravitreal conbercept injection and (or) macular grid pattern photocoagulation in treating macular edema secondary to non-ischemic branch retinal vein occlusion (BRVO). Methods Ninety eyes of 90 patients diagnosed as macular edema secondary to non-ischemic BRVO were enrolled in this study. Forty-eight patients (48 eyes) were male and 42 patients (42 eyes) were female. The average age was (51.25±12.24) years and the course was 5–17 days. All patients were given best corrected visual acuity (BCVA), intraocular pressure, slit lamp with preset lens, fluorescence fundus angiography (FFA) and optic coherent tomography (OCT) examination. The patients were divided into conbercept and laser group (group Ⅰ), laser group (group Ⅱ) and conbercept group (group Ⅲ), with 30 eyes in each group. The BCVA and central macular thickness (CMT) in the three groups at baseline were statistically no difference (F=0.072, 0.286;P=0.930, 0.752). Patients in group Ⅰ received intravitreal injection of 0.05 ml of 10.00 mg/ml conbercept solution (conbercept 0.5 mg), and macular grid pattern photocoagulation 3 days later. Group Ⅱ patients were given macular grid pattern photocoagulation. Times of injection between group Ⅰ and Ⅲ, laser energy between group Ⅰ and Ⅱ, changes of BCVA and CMT among 3 groups at 1 week, 1 month, 3 months and 6 months after treatment were compared. Results Patients in group Ⅰ and Ⅲ had received conbercept injections (1.20±0.41) and (2.23±1.04) times respectively, and 6 eyes (group Ⅰ) and 22 eyes (group Ⅲ) received 2-4 times re-injections. The difference of injection times between two groups was significant (P<0.001). Patients in group Ⅱ had received photocoagulation (1.43±0.63) times, 9 eyes had received twice photocoagulation and 2 eyes had received 3 times of photocoagulation. The average laser energy was (96.05±2.34) μV in group Ⅰ and (117.41±6.85) μV in group Ⅱ, the difference was statistical significant (P=0.003). BCVA improved in all three groups at last follow-up. However, the final visual acuity in group Ⅰ and group Ⅲ were better than in group Ⅱ (t=4.607, –4.603;P<0.001) and there is no statistical significant difference between group Ⅲ and group Ⅰ (t=–0.802,P=0.429). The mean CMT reduced in all three groups after treating for 1 week and 1 month, comparing that before treatment (t=–11.855, –10.620, –10.254;P<0.001). There was no statistical difference of CMT between group Ⅰand Ⅲ at each follow up (t=0.404, 1.723, –1.819, –1.755;P=0.689, 0.096, 0.079, 0.900). CMT reduction in group Ⅰ was more than that in group Ⅱ at 1 week and 1 month after treatments (t=–4.621, –3.230;P<0.001, 0.003). The CMT in group Ⅲ at 3 month after treatment had increased slightly comparing that at 1 month, but the difference was not statistically significant (t=1.995,P=0.056). All patients had no treatment-related complications, such as endophthalmitis, rubeosis iridis and retinal detachment. Conclusions Intravitreal conbercept injection combined with macular grid pattern photocoagulation is better than macular grid pattern photocoagulation alone in treating macular edema secondary to non-ischemic BRVO. Combined therapy also reduced injection times comparing to treatment using conbercept injection without laser photocoagulation. Key words: Retinal vein occlusion/therapy; Macular edema /therapy; Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal/therapeutic use; Laser coagulation

Pars plana vitrectomy with juxtapapillary laser photocoagulation versus vitrectomy without juxtapapillary laser photocoagulation for the treatment of optic disc pit maculopathy: the results of the KKESH International Collaborative Retina Study Group

Background/aimsTo compare the functional and anatomic outcomes of pars plana vitrectomy (PPV) with juxtapapillary laser photocoagulation (JLP) versus vitrectomy without JLP in optic disc pit maculopathy.MethodsThis was a multicentre, retrospective...

Vision, Retinal Thickness, and Foveal Avascular Zone Size After Intravitreal Bevacizumab for Diabetic Macular Edema

To investigate three monthly intravitreal bevacizumab (IVB) injections effects in chronic diabetic macular edema (DME). A prospective, noncomparative study in which inclusion criteria were; DME with central macular thickness (CMT) of at least 250 μm, and no treatment for diabetic retinopathy (DR) within 4 months before the first injection. All eyes received three monthly 1.25 mg IVB injections. CMT by optical coherence tomography, visual acuity (VA), foveal avascular zone (FAZ) greatest linear dimension (GLD), and area of FAZ by fundus fluorescein angiography were documented initially and 1 month after last injection. Outcomes (P<0.05 were significant) and correlations (r values) were analyzed. A total of 29 eyes of 29 patients (group 1, 19 female, 10 male), aged 60.7±6.6 years were analyzed. The patients were split into two groups; group 2 included 15 mild-to-moderate nonproliferative DR, and group 3 included 14 more-severe DR. VA gain was significant in all groups (P<0.05). Mean CMT decrease was approximately 46, 36, and 55 μm in groups 1, 2, and 3, respectively (P<0.05 only in group 1). A 0.045-mm2 increase in FAZ area was obtained in group 1 (P<0.05). In group 2, an increase in GLD and area of FAZ was 0.048 mm and 0.058 mm2, respectively (P<0.05), whereas in group 3, FAZ enlargement was nonsignificant. VA and CMT were significantly correlated (r values=0.5-0.6), except for the final VA-final CMT in group 2. FAZ dimensions and other parameters (VA and CMT) were noncorrelated. According to the authors' short-term results, three monthly IVB injections can be used for chronic DME regardless of VA, CMT, or FAZ dimensions, despite the FAZ enlargement encountered, especially in cases with milder DR.