Cystoid Macular Edema Group Research Articles

Optical Coherence Tomography Angiography as a Diagnostic Tool in Cystoid Macular Edema

Abstract Background Cystoid macular edema (CME) represents a common pathologic sequel of the retina and occurs in a variety of pathological conditions such as intraocular inflammation, central or branch retinal vein occlusion, diabetic retinopathy and most commonly following cataract extraction. Aim of the Work To evaluate the role of optical coherence tomography angiography in the diagnosis of cystoid macular edema. Patients and Methods We applied our study on thirty eyes will be divided into two equal groups: CME group (n = 15 eyes) and Control group (n = 15 eyes), with the same inclusion and exclusion criteria. This study included thirty eyes of twenty four patients. There were 15 patients of unilateral; while the right eye was affected in 7 patients (46.7%) and the left eye in 8 (53.3% patients in CME group; while there were 6 patients of bilateral and 3 patients of unilateral; while the right eye was affected in 7 patients (46.7%) and the left eye in 8 (53.3%) patients in control group. Results This study showed that in term of Sex, there is no statistically significant difference between the groups with p-value (p = 0.134). There was a statistically significant higher mean age in CME group compared to control group with p-value (p = 0.005). Also laterality were comparable in each of CME group were 0 patients (%) and 15 patients (100%) were bilateral and unilateral, respectively compared to control group were 6 patients (66.7%) and 3 patients (33.3%) were bilateral and unilateral respectively in term of laterality, there was a statistically significant with p-value (p = 0.002). There was a statistically significant higher mean in CME group compared to control group according to unaided visual acuity and best corrected visual acuity, with p-value (p < 0.001). The mean BCVA was 0.2#0.15, 0.48÷0.23, and 1.06‡0.27 log MAR for early, advanced, and severe DME. Log MAR visual acuity was significantly different among different DME grades (P < 0.001). There was a statistically significant higher ocular surgeries in in CME group compared to control group, with p-value (p < 0.001). That was a statistically significant higher OCTA findings in CME group compared to control group, with p-value (p < 0.001); as for the CFT there was a higher mean value in CME group was 484.2070.05 compared to 233.93=13.51, with p-value (p < 0.001). Conclusion In conclusion, cystoid macular edema (CME) can be identified early and OCTA can contribute to the clinical characterisation of the disease.

The Responses of Different Types of Diabetic Macular Edema after Three Loading Doses of Anti-vascular Growth Factor: Outcomes in Two Medical Centers

Background: Diabetic macular edema (DME) is currently treated by anti-vascular endothelial growth factor (anti-VEGF). Aim: The aim of this study was to evaluate the effect of intravitreal anti-VEGF in different types of DME classified by optical coherence tomography (OCT). Methods: This retrospective study included 161 treatment-naive eyes (116 patients) diagnosed with DME in two tertiary medical centers, which were classified into three groups according to initial OCT finding: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). All eyes received three monthly loading doses of anti-VEGF. Primary and secondary outcomes were the improvement of best-corrected visual acuity (BCVA) and the decrease of central foveal thickness (CFT) on OCT, respectively. Results: Among the three groups, there was no significant difference in baseline BCVA (P = 0.137); however, the SRD group had the thickest baseline CFT (P < 0.001). After three loading doses of anti-VEGF, the BCVA of all three groups improved from baseline (DRT vs. CME vs. SRD, P = 0.0002, P < 0.0001, and P < 0.0001, respectively), while the SRD group seemed to have relatively better improvement among three groups although not significant (P = 0.051). The CFTs of all three groups significantly decreased from baseline (P < 0.0001 in all three groups). The CFT decreased the most in the SRD group, followed by the CME group, and the least in the DRT group (P < 0.001). Conclusion: Anti-VEGF therapy improved the anatomical structure and function in all types of DME; SRD responded the best.

Evaluation of photoreceptor features in retinitis pigmentosa with cystoid macular edema by using an adaptive optics fundus camera.

Cystoid macular edema (CME) in retinitis pigmentosa (RP) is an important complication causing visual dysfunction. We investigated the effect of CME on photoreceptors in RP patients with previous or current CME, using an adaptive optics (AO) fundus camera. We retrospectively observed the CME and ellipsoid zone (EZ) length (average of horizontal and vertical sections) by optical coherence tomography. The density and regularity of the arrangement of photoreceptor cells (Voronoi analysis) were examined at four points around 1.5° from superior to inferior and temporal to nasal. We also performed a multivariate analysis using CME duration, central macular thickness and transversal length of CME. We evaluated 18 patients with previous or current CME (18 eyes; age, 48.7 ± 15.6 years) and 24 patients without previous or current CME (24 eyes; age, 46.0 ± 14.5 years). There were no significant differences in age, logMAR visual acuity, or EZ length. In groups with and without CME, cell density was 11967 ± 3148 and 16239 ± 2935 cells/mm2, and sequence regularity was 85.5 ± 3.4% and 88.5 ± 2.8%, respectively; both parameters were significantly different. The correlation between photoreceptor density and age was more negative in group with CME. The CME group tended toward greater reductions in duration of CME. Complications of CME in RP patients may lead to a decrease in photoreceptor density and regularity. Additionally, a longer duration of CME may result in a greater reduction in photoreceptor density.

Prevalence and associated factors of cystoid macular edema in children with early onset inherited retinal dystrophies.

To assess the prevalence of Cystoid macular edema (CME) in children with early onset retinal dystrophies (EORD) and to evaluate if there are associated factors and/or response to early treatment. Consecutive, retrospective case series. Medical records of patients, 18 years or younger, diagnosed with EORD were included in the study. Optic coherence tomography (OCT) scans, clinical and genetic characteristics as well as other associated factors were analyzed. Main outcome was the presence of CME on OCT scans. One hundred and two children with EORD (aged 1-18 years, mean 9.7 ± 4.2) were recruited. OCT was performed in 60/102 and among them, 19/60 had CME (31.7%). The disease-causing gene was identified in 13 children with CME; autosomal-recessive inheritance was found in 88.3% of those with an identified genotype. Children with Usher syndrome had CME in 44.4% of the cases. Early treatment of CME resulted in variable response. Our results show that 31.7% of children with EORD who underwent OCT have macular edema. CME prevalence was found to be relatively higher in children with Usher syndrome. Autosomal recessive was the most prevalent inheritance identified in the EORD group as well as in the CME group. Additional prospective research is needed to assess the efficacy of early CME treatment in pediatric EORD patients.

Analysis of optical coherence tomography angiographic findings of prematurely born children and its relationship with macular edema of prematurity

To compare foveal avascular zone (FAZ) area, foveal vascular density (VD), and foveal thickness in pre- and full-term children and to evaluate their relationship with cystoid macular edema (CME) in the prematurity period using spectral domain optical coherence tomography angiography (SD-OCTA). OCTA imaging was performed at 4-6 years of age in 90 eyes of 45 prematurely born children and 50 eyes of 25 term children. Subjects were divided into three groups: prematurely born with CME (group 1); prematurely born without CME (group 2); healthy, term children (group 3). Imaging results in the three groups were compared. FAZ area was significantly larger in group 3 than in groups 1 and 2 (P < 0.001 [ANOVA]). FAZ area was found to be correlated with birth weight (r = 0.511; P < 0.001) and gestational age (r = 0.532; P < 0.001). No significant relationship was found between history of CME and FAZ area. In our study cohort, FAZ area was smaller in prematurely born children and was correlated with older gestational age and higher birth weight. CME in the neonatal period did not seem to affect retinal microvascular development in premature infants.

Efficacy of intravitreal conbercept injection on short- and long-term macular edema in branch retinal vein occlusion

To observe the best-corrected visual acuity (BCVA) and central foveal thickness (CFT) repeatedly after the intravitreal injection of conbercept (IVC) for treating cystoid macular edema (CME) in branch retinal vein occlusion (BRVO) and explore the relationship between the duration of CME and visual outcome. Subgroup analysis was performed to compare short-term (within 90d of CME onset) and long-term (over 90d of CME onset) macular edema in BRVO. After an initial IVC, a pro re nata (PRN) strategy was performed according to the recurrence of CFT or decrease of BCVA. Analysis of variance using repeated measurements, statistical analysis following indicators including BCVA and CFT collected at baseline and 1, 3, and 6mo after IVC. Among the 60 cases included in this retrospective study, 36 were short-term CME, and 24 were long-term CME. There were statistical significances between and within groups of the BCVAs at different time points (P<0.001). The interaction was found between group and time (P=0.006), indicating the difference in the speed of BCVA improvement between groups. In particular, the improvement speed of BCVA in the short-term CME group was faster than that in the long-term CME group. There were significant differences between and with groups of the CFT at different time points (P<0.001). However, the interaction between group and time in relation to CFT had no significant differences (P=0.59). IVC treatment for CME following BRVO is effective and safe. The duration of CME before treatment is a significant predictor of the visual outcomes of patients with BRVO. The improvement of vision might be faster with early IVC treatment than with delayed treatment.

Clinical Characteristics Associated with the Development of Cystoid Macular Edema in Patients with Cytomegalovirus Retinitis.

We evaluated the incidence and characteristics of eyes with cytomegalovirus (CMV) retinitis according to the occurrence of cystoid macular edema (CME) and identified the risk factors of its occurrence. Patients diagnosed with CMV retinitis and examined using optical coherence tomography were classified according to the development of CME. The CME group was further divided according to the presence of active retinitis at the time of CME development. The demographics, serologic findings, ophthalmic presentations, ocular treatments, and visual prognosis were compared. CME was identified in 25 eyes (17 eyes with active retinitis and 8 eyes with inactive retinitis) out of the 67 eyes with CMV retinitis. Visual acuity was worse in the CME group than in the non-CME group. The CME group had longer CMV viremia duration, zone 1 involvement, and larger extent of CMV retinitis. While CME with concurrent active retinitis developed in eyes with direct foveal involvement of retinitis in the acute phase and required more ganciclovir injections after CME development, CME without active retinitis developed in eyes with larger extents of involvement and more intravitreal ganciclovir injections before CME development. Zone 1 involvement and longer CMV viremia duration were independently associated with the occurrence of CME. CME, which caused visual deterioration, developed in considerable patients with CMV retinitis and had different characteristics according to the presence of active retinitis.

Subfoveal choroidal thickness changes after intravitreal ranibizumab injections in different patterns of diabetic macular edema using a deep learning-based auto-segmentation.

To evaluate the effect of intravitreal injection of ranibizumab (IVR) on subfoveal choroidal thickness (SFCT) and its relationship with central macular thickness (CMT) and best-corrected visual acuity (BCVA) changes in eyes with center-involving DME (CI-DME) using a deep learning-based auto-segmentation. This prospective interventional case series included 68 eyes of 68 patients with CI-DME naive to treatment. Morphological optical coherence tomography (OCT) findings of DME were classified into three patterns of structural change: (i) diffuse retinal thickening (DRT), (ii) cystoid macular edema (CME), and (iii) serous retinal detachment (SRD). All patients underwent 3+prorenata IVR. The treated eyes underwent BCVA evaluation and OCT scanning at baseline and months 1, 3, and 6 after the first injection. Then, the choroid layer was measured using a deep learning-based auto-segmentation. At baseline, the mean SFCT and CMT for SRD, DRT, and CME groups were 324.68 ± 65.58μm and 624.37 ± 77.92μm, 348.91 ± 45.81μm and 443.5 ± 78.33μm, 361.4 ± 64.62μm, and 536.5 ± 66.02μm, respectively. After anti-VEGF treatment, the SFCT and CMT have decreased by varying degrees. At 3 and 6months of treatment, there were no significant changes among these groups. There was no correlation between baseline SFCT and the resulting BCVA (P = 0.670, P = 0.584). There was also no correlation between changes in SFCT and BCVA, CMT (P = 0.344, P = 0.336). After treating CI-DME with IVR, SFCT and CMT significantly decreased. However, there were no significant changes among the SRD, DRT, and CME groups. Trial registration: ChiCTR, ChiCTR-ROC-17013360. Registered 13 November 2017, http://www.chictr.org.cn/ChiCTR-ROC-17013360 .

Macular edema after rhegmatogenous retinal detachment repair: risk factors, OCT analysis, and treatment responses

PurposeTo investigate risk factors, imaging characteristics, and treatment responses of cystoid macular edema (CME) after rhegmatogenous retinal detachment (RRD) repair.MethodsConsecutive, retrospective case–control series of patients who underwent pars plana vitrectomy (PPV) and/or scleral buckling (SB) for RRD, with at least six months of follow-up. Clinical and surgical parameters of patients with and without CME (nCME), based on spectral-domain optical coherence tomography (OCT), were compared.ResultsOf 99 eyes enrolled, 25 had CME while 74 had nCME. Patients with CME underwent greater numbers of surgeries (P < 0.0001). After adjusting for number of surgeries, macula-off RRD (P = 0.06), proliferative vitreoretinopathy (PVR) (P = 0.09), surgical approach (PPV and/or SB, P = 0.21), and tamponade type (P = 0.10) were not statistically significant, although they all achieved significance on univariate analysis (P = 0.001 or less). Intraoperative retinectomy (P = 0.009) and postoperative pseudophakia or aphakia (P = 0.008) were more frequent in the CME group, even after adjustment. Characteristics of cCME on OCT included diffuse distribution, confluent cysts, and absence of subretinal fluid or intraretinal hyperreflective foci. Macular thickness improved significantly with intravitreal triamcinolone (P = 0.016), but not with anti-vascular endothelial growth factor agents (P = 0.828) or dexamethasone implant (P = 0.125). After adjusting for number of surgeries and macular detachment, final visual acuities remained significantly lower in the CME vs nCME group (P = 0.012).ConclusionRisk factors of CME include complex retinal detachment repairs requiring multiple surgeries, and pseudophakic or aphakic lens status. Although this cCME was associated with poor therapeutic response, corticosteroids were the most effective studied treatments.

Optical Coherence Tomographic Patterns as Predictors of Structural Outcome After Intravitreal Ranibizumab in Diabetic Macula Edema.

Background/ObjectivesThe purpose of this study was to present an association between the treatment response of diabetic macular edema (DME) to intravitreal ranibizumab (IVR) injections and different morphology patterns using spectral domain optical coherence tomography (SD-OCT).Subjects/MethodsThis retrospective study included 216 eyes of 142 subjects who received IVR for DME and were observed for at least 2 years. Medical charts and SD-OCT images of consecutive patients were reviewed at baseline, 1, 3, 6, 12, and 24 months after first IVR treatment. The OCT patterns were characterized as diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). All patients were classified into four groups based on the OCT findings.ResultsFor a total of 216 eyes, 36 eyes were classified into the DRT group, 76 in the CME group, 42 in the SRD group, and 62 in the VMIA group. There were significant central macula thickness (CMT) improvements in all groups at the 1st month and the 2nd year, except for the DRT group at the 2nd year. Patients with OCT findings of hyperreflective dots (HRDs), metabolic parameters of hyperlipidemia, and coronary artery disease (CAD) had significantly less improvements in CMT at 2-year follow-up (P=0.029, 0.007, <0.001, respectively).ConclusionA trend toward decreased effectiveness after long-term IVR treatment was observed in the DRT group. Consistent IVR treatment could still achieve favorable improvement in the reduction of CMT in 2-year follow-up in the VMIA group. Different OCT patterns in DME may affect the therapeutic role of anti-VEGF agents and predict the structure outcome.

Comparison of intravitreal anti-vascular endothelial growth factor agents and treatment results in Irvine-Gass syndrome.

To compare the efficacy of bevacizumab, ranibizumab, and aflibercept in pseudophakic cystoid macular edema (CME) patients with Irvine-Gass syndrome (IGS). This study is designed as retrospective consecutive case series. Those who developed postoperative pseudophakic CME that refractory to topical treatment and were treated with anti-vascular endothelial growth factor (VEGF) agents included in the study. Optical coherence tomography (OCT) examination including central macular thickness (CMT), total macular volume (TMV), retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) and choroidal thickness (ChT) measurements at the baseline, 1st, 3rd and 6th month controls were performed. Fifty-nine eyes of 59 patients with CME and other healthy eyes of the patients (Control group) were evaluated. There were 22 eyes of 22 patients in the bevacizumab group (group 1), 19 eyes of 19 patients in the ranibizumab group (group 2), and 18 eyes of 18 patients in the aflibercept group (group 3). There was no difference in terms of age, gender, axial length, IOP, and spherical equivalent values. The baseline subfoveal and mean ChT were higher in the IGS group. The difference between the baseline and sixth month values of subfoveal and mean ChT were compared in the CME groups, thinning was observed in all three groups. GCL was thinner in the patient group at the 6th month of treatment. The resolution time of CME was observed faster in group 1. All three anti-VEGF agents seem to be effective in CME but bevacizumab appears to be slightly more cost-effective than the other two alternatives.

Defining Cystoid Macular Degeneration in Diabetic Macular Edema: An OCT-Based Single-center Study

Objectives:To describe cystoid macular degeneration (CMD), which has no clear definition in diabetic macular edema (DME), and examine its features in optical coherence tomography (OCT) and fundus fluorescein angiography (FFA).Materials and Methods:This study was conducted using OCT images of patients who were followed in Gazi University between November 2011 and March 2015. A total of 259 eyes (187 patients) found to have cystic changes on OCT were included. Macular ischemia, peripheral ischemia, and type of edema were identified on FFA. Vitreomacular interface abnormalities, foveal contour integrity, internal reflectivity of the cysts, and outer retinal layer defects were analyzed from OCT images. The horizontal and vertical diameters of the largest cyst within 1000 μm of the foveal center were measured for the definition of CMD. Cut-offs for these values were determined by receiver operating characteristic curve analysis. Cystoid macular edema (CME) and CMD groups were created and their characteristics were analyzed.Results:The horizontal and vertical diameters of the largest cyst were moderately positively correlated with visual acuity (rs=0.349, r=0.419, respectively). Eyes with horizontal diameter of the largest cyst ≥450 μm were classified as CMD; in this group, sensitivity in the prediction of visual acuity ≤20/60 was 58%. Eyes with horizontal diameter of the largest cyst <450 μm were classified as CME; in this group, specificity in the prediction of visual acuity >20/60 was 73%. For the threshold of 300 μm determined for vertical diameter of the largest cyst, sensitivity was 62% and specificity was 69%. The CME and CMD groups were formed according to these cut-off values. Compared to the CME group, the CMD group had greater central subfield thickness and higher prevalence of outer retinal damage, severe disruption of foveal contour, macular ischemia, and diffuse/mixed type edema.Conclusion:In eyes with DME, CMD can be defined as the largest cyst within 1000 μm of the foveal center having a horizontal diameter of ≥450 μm and vertical diameter ≥300 μm, especially if associated with macular ischemia, outer retinal damage, loss of foveal contour, and diffuse/mixed type edema.

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.

Analysis of anatomical biomarkers in subtypes of diabetic macular edema refractory to anti-vascular endothelial growth factor treated with dexamethasone implant.

To analyze functional and anatomical outcomes in subtypes of diabetic macular edema treated with a single dexamethasone implant and to assess the usefulness of a pro-re-nata treatment among subtypes. Retrospective study in morphologic patterns of diabetic macular edema (diffuse retinal thickening n = 15; cystoid macular edema n = 38, and serous retinal detachment n = 17) recalcitrant to anti-vascular endothelial growth factor, treated with dexamethasone implant. Examinations included timing to recidive of diabetic macular edema, best-corrected visual acuity, and central subfield macular thickness at 2, 4, and 6 months. In previously treated patients with a mean of 6.64 ± 3.69 anti-vascular endothelial growth factor injections, the best-corrected visual acuity improved from 61.64 ± 13.71 to 65.71 ± 14.65 as per the Early Treatment Diabetic Retinopathy Study protocol (p = 0.009) and central subfield macular thickness change from 447.46 ± 110.82 to 354.39 ± 80.46 µm (p < 0.005). The best-corrected visual acuity improvement was better in the diffuse retinal thickening group (68.67 ± 13.81 vs 65.26 ± 14.04 in cystoid macular edema and vs 64.12 ± 17.06 in serous retinal detachment), whereas higher central subfield macular thickness thinning was observed in serous retinal detachment group (368.47 ± 29.96 to 310.27 ± 67.47 in diffuse retinal thickening, vs 445.92 ± 105.06 to 364.39 ± 80.28 and 520.59 ± 122.96 to 370.94 ± 81.73 in cystoid macular edema and serous retinal detachment, respectively). Cystoid macular edema group was the group with more recurrences after 6 months (86.8% vs 66.7% in diffuse retinal thickening and 70.6% in serous retinal detachment). Dexamethasone implant is effective for all persistent diabetic macular edema subtypes with sustained functional and morphologic gains in the first 6 months.

The efficacy of intravitreal injection of conbercept on different types of macular edema induced by branch retinal vein occlusion

Objective To investigate the clinical efficacy of intravitreal injection of conbercept on different types of macular edema (ME) induced by branch retinal vein occlusion (BRVO). Methods A prospective case-control study was designed.Fifty-six eyes of 56 patients diagnosed with ME secondary to BRVO in Weifang Eye Hospital between May 2016 and May 2017 were chosen for this study.According to the morphologies of ME through optical coherence tomography (OCT), patients were divided into 3 groups: 15 cases 15 eyes with serous retinal detachment (SRD), 19 cases 19 eyes with cystoid macular edema (CME), and 22 cases 22 eyes with mixed edema.All of the patients received intravitreal injection of conbercept using 1+ PRN method and followed up for 6 months.When the change of central macular thickness (CMT) exceed 100 μm, repeat the injection.The best corrected visual acuity (BCVA) and CMT before and after treatment for 1 week, 1 month and 6 months and the average injection times were compared among different groups and time points.This study was approved by the Ethic Committee of Weifang Ophthalmic Hospital.Informed consent was signed from each patient before any treatments were proceeded. Results The differences of BCVA (LogMAR vision) at different time points before and after treatment among the 3 groups were statistically significant (Fgroup=105.834, P=0.000; Ftime=68.070, P=0.000). One month after treatment, BCVA in SRD group was the best, the next was CME group, and BCVA in mixed edema group was the poorest, and the difference between SRD group and mixed edema group was statistically significant (P<0.05). Six months after treatment, BCVA in SRD group was the best, the next was CME group, and BCVA in mixed edema group was the poorest, the differences compared with each other were statistically significant (all at P<0.05). The BCVA after treatment were improved than those before treatment in all the three groups, BCVA in 6 months after treatment was improved than that in 1 week and 1 month after treatment in each group, the differences were statistically significant (all at P<0.05). The differences of CMT at different time points among the 3 groups were statistically significant (Fgroup= 68.640, P=0.000; Ftime=29.783, P=0.000). CMT in mixed edema group before treatment was thicker than that in the SRD group and CME group, with significant differences between them (all at P<0.05). The CMT after treatment were thinner than those before treatment in 3 groups, with significant differences between them (all at P<0.05). With the extension of time, CMT was thinner gradually in each group, the differences of CMT in 1 week, 1 month, 6 months after treatment were statistically significant (all at P<0.05). The number of injections in 6 months was statistically different among the three groups (F=12.479, P=0.000). The number of injections in SRD group was less than that in the CME group and mixed edema group, and the differences were statistically significant (P=0.001, 0.000). Among the patients who still need to be injected or laser treatment after 6 months of treatment, 1 patient was SRD type ME (6.7%), 3 patients were CME type ME (15.8%), and 5 patients were mixed type ME (22.7%). Conclusions The efficacy of intravitreal injection with conbercept on different types of ME induced by BRVO was definitive, which can effectively improve BCVA and reduce ME; of which, the number of average injection times in SRD group is the least and its prognosis is best, just followed by CME group, while the number of injection times in mixed edema group is the largest and its prognosis is the poorest. Key words: Conbercept; Macular edema; Branch retinal vein occlusion; Efficacy study

Visually Significant Cystoid Macula Edema After Glaucoma Drainage Implant Surgery.

This study examines the incidence of visually significant cystoid macular edema (CME) after glaucoma drainage implant (GDI) surgery and analyses risk factors associated with developing CME and prognosis with treatment. In total, 185 eyes from 185 glaucoma patients (mean age, 72.46±13.94 y) who underwent GDI surgery at a tertiary eye institute were recruited. Patients were classified based on the presence (CME) or absence (No-CME) of CME. Pre-GDI and post-GDI best-corrected visual acuity, number of intraocular pressure (IOP)-lowering medications, IOP, standard automated perimetry and post-GDI complications, were recorded and compared between the 2 groups. Optical coherence tomography (OCT) was used to quantify retinal thickness and monitor CME. In total, 41 (22.2%) eyes developed visually significant CME after GDI surgery. Patients with CME had a higher incidence of pre-GDI nonsteroidal anti-inflammatory drug (P<0.01) use and higher number of prior glaucoma surgeries (P<0.01). CME patients had a higher (P<0.01) incidence of iritis, epiretinal membrane, and hypotony. CME eyes responded well to steroids, with resolving macular edema (458.4±151.9 vs. 322.0±92.0 µm, P<0.01) and improving visual acuity (0.73±0.48 vs. 0.56±0.56 logarithm of minimum angle of resolution, P<0.01). Both CME and non-CME groups had equivalent lowering of IOP and post-GDI glaucoma medications; with no significant elevation in IOP in the steroid-treated CME group. Post-GDI surgery visually significant CME rates are potentially higher in a real hospital scenario compared with controlled clinical trials. With diligent treatment, CME resolves effectively restoring visual acuity and central macular thickness.

Effectiveness of Intravitreal Ranibizumab for Diabetic Macular Edema with Serous Retinal Detachment.

To evaluate the effectiveness of intravitreal injection of ranibizumab (IVR) in treating diabetic macular edema (DME) with serous retinal detachment (SRD) based on spectral domain optical coherence tomography (SD-OCT) patterns. One hundred thirty-four eyes of 134 patients with DME who underwent SD-OCT evaluation were included in this study. We retrospectively analyzed the medical records of patients who received IVR for the treatment of DME. Their eyes were classified into three groups according to the following SD-OCT features: SRD, diffuse retinal thickness and cystoid macular edema. The three groups were compared regarding changes in best-corrected visual acuity and central foveal thickness (CFT) after IVR. The mean age was 61.4 ± 9.2 years (range, 44 to 81 years). The average length of the follow-up period was 9.4 ± 3.4 months (range, 6 to 24 months). The mean CFT value was significantly reduced in all groups (p < 0.001) after treatment. Increases in best-corrected visual acuity were statistically significant for the diffuse retinal thickness and cystoid macular edema groups (p < 0.001 and p < 0.001, respectively). However, there was no significant improvement after IVR injection in the SRD group (p = 0.252). In the SRD group, patients with ellipsoid zone disruption and external limiting membrane disruption demonstrated poorer visual gains at the last follow-up visit (p < 0.005 and p = 0.002, respectively). A significant reduction in CFT with required IVR injections in DME with SRD was achieved but was accompanied by a worse functional outcome in the SRD group. The presence of subretinal fluid on SD-OCT in study eyes may be a poor prognostic factor for visual acuity.

Incidence and Risk Factors of Cystoid Macular Edema after Vitrectomy with Silicone Oil Tamponade for Retinal Detachment.

To investigate the incidence and risk factors of cystoid macular edema (CME) after silicone oil (SO) injection for retinal detachment. Fifty-eight patients with retinal detachment treated by vitrectomy with SO tamponade during 2011 to 2015 were retrospectively assigned to CME and non-CME groups. Patients underwent complete ophthalmological examination, including color fundus photography and preoperative and postoperative optical coherence tomography. Risk factors for CME during SO tamponade were determined by regression analyses. Of the 58 eyes, 21 (36.2%) exhibited CME. The presence of posterior staphyloma in the CME group was significantly more frequent than in the non-CME group (p = 0.026). There were no significant differences in other demographic or clinical characteristics between the CME and non-CME groups. Significant correlations were observed between CME after vitrectomy with SO tamponade and the presence of posterior staphyloma (odds ratio, 4.03; p = 0.031). Of the 21 eyes with CME, 13 underwent SO removal, among which 11 experienced resolution of CME with or without further intervention. The presence of posterior staphyloma is significantly associated with CME after vitrectomy with SO tamponade. Patients with retinal detachment exhibiting posterior staphyloma should be evaluated for potential CME during SO tamponade.

CORRELATION OF OPTICAL COHERENCE TOMOGRAPHIC HYPERREFLECTIVE FOCI WITH VISUAL OUTCOMES IN DIFFERENT PATTERNS OF DIABETIC MACULAR EDEMA.

To investigate the correlation between the hyperreflective foci (HF) on spectral domain optical coherence tomography at the baseline and visual outcomes after intravitreal bevacizumab injections in different patterns of diabetic macular edema. We retrospectively reviewed the medical records of 97 eyes (80 patients) with diabetic macular edema that were treated with intravitreal bevacizumab injection. The eyes were categorized into three groups by optical coherence tomographic features: diffuse retinal thickening, cystoid macular edema, and serous retinal detachment. The baseline and final best-corrected visual acuity, foveal thickness, the number of HF, and status of the external limiting membrane and the ellipsoid zone were evaluated and compared among the three groups. The number of HF in all retinal layers was reduced in patients with diabetic macular edema after treatment. In multivariate regression analysis, the final visual acuity was associated with baseline visual acuity (P = 0.004) and number of outer retinal HF (P = 0.004) in the diffuse retinal thickening group, baseline visual acuity (P = 0.002) and number of outer retinal HF (P < 0.001) in the cystoid macular edema group, and baseline number of inner and outer retinal HF (P = 0.041, P = 0.025, respectively) in the serous retinal detachment group. The baseline number of the outer retinal HF was correlated with the final visual acuity, ellipsoid zone disruption length, and external limiting membrane disruption length in all three groups. The number of HF in outer retinal layer on spectral domain optical coherence tomography at baseline might predict the final visual acuity in all three patterns of diabetic macular edema groups.