Decrease In Macular Edema Research Articles

Branch Retinal Vein Occlusion Occurring After Second Dose of Sinopharm COVID-19 Vaccine: A Case Report

: An old-aged woman was evaluated with branch retinal vein occlusion (BRVO) vision reduction in his left eye three weeks after the Sinopharm coronavirus disease 2019 (COVID-19) vaccination. Her best-corrected visual acuity (BCVA) was 1m counting finger in the left eye and 10/10 in the right eye. Initial retinal findings were superior retinal hemorrhage with prominent retinal vein dilation and tortuosity in the left eye. Fluorescein angiography (FA) and optical coherence tomography (OCT) confirmed a BRVO diagnosis. Blood reports showed no abnormalities. Antithrombotic treatment of 80 mg/d low-dose entrocoated ASA was administered. In addition, an intravitreal Aflibercept (Eylea) injection, monthly and ongoing, was prescripted, which led to a decrease in macular edema, retinal hemorrhage, and height of serous retinal detachment. Moreover, the BCVA improved to 2/10 after a three-week follow-up.

To study the effect of intravitreal ozurdex implant in cases of retinal vein occlusion

Introduction: Retinal vein obstruction is one of the leading causes of severe vision impairment and blindness with treatment options mainly including laser, vascular endothelial growth factors, and steroids. This study investigates an intravitreal dexamethasone implant (ozurdex), its efficacy, and complications in patients of retinal venous occlusion. Methods: A prospective, interventional study involving 30 patients with retinal venous occlusion. Patients diagnosed with RVO who had vision loss of at least two lines on Snellen's chart and increased central macular thickness (CMT) on OCT were included in the study. All the parameters such as best-corrected visual acuity (BCVA), CMT, and intraocular pressure (IOP) were noted at baseline for the affected eye. The patients were followed up at 1 month, 2 months, and 3 months following the implant. Result: Baseline parameters were comparable between the groups. Eyes receiving the implant had a statistically significant improvement (P < 0.001) in BCVA on the Snellen chart over the 3 months. There was also a constant decrease in macular edema and the mean difference value of CMT between baseline and 1 month, 2 months, and 3months were also found to be statistically significant. Also, a comparison of IOP between two-time points was done, between baseline and 1 month, 2 months, 3 months, and the mean difference value in IOP was also found to be significant but clinically well within the normal physiological range. Conclusion: The study concluded that an intravitreal dexamethasone implant is an effective treatment for retinal venous occlusion, and it has a statistically significant and clinically meaningful effect on BCVA and CMT. However, it may be associated with a significant rise in IOP but it is well within the physiological range.

Brolucizumab: Evaluation of Compassionate Use of a Complex Anti-VEGF Therapy.

ObjectiveTo report a consecutive series of compassionate, off-label use of intravitreal brolucizumab as a rescue therapy for complex, non-responsive macular edema. This report delineates primary diagnosis, indications for treatment, adverse events, and visual and anatomic outcomes after intravitreal brolucizumab.MethodsA retrospective review of a consecutive clinical case series of 110 eyes treated with intravitreal brolucizumab between January 1st and March 1st. 2020. All patients were included if they received intravitreal brolucizumab in an off-label delivery and had ongoing macular edema in the setting of prior, multiple intravitreal anti-VEGF and/or intravitreal triamcinolone acetonide. All patients had spectral domain OCT documented before, at the time of, and in serial follow-up after intravitreal brolucizumab.ResultsNinety-eight of 98 patients had marked decrease in macular edema. Indications for treatment were assigned to the primary etiologic diagnosis leading to the macular edema secondary to radiation retinopathy, complex epiretinal membrane, or complex diabetic retinopathy. In this series, sdOCT central point thickness decreased by an average of 71.5 microns, subretinal fluid resolved, and visual acuity was improved in 40% (greater than two Snellen lines) and stable in 60% (within two Snellen lines). No patient experienced a severe adverse event to specifically include vitritis and/or vasculitis.ConclusionIn this series, brolucizumab intravitreal injection was associated with significant improvement in macular edema in each diagnostic category. No serious complications to treatment were found in this series. Brolucizumab, though associated with known intraocular inflammation and vasculitis, demonstrated marked benefit in these complex eyes previously unresponsive to aggressive intravitreal pharmacotherapy.

EFFECT OF STATIN USE ON STATUS OF DIABETIC ETINOPATHY/ DIABETIC MACULAR EDEMA IN PATIENTS OF TYPE 2 DIABETES MELLITUS

AIM: Effect of statin use on status of diabetic retinopathy /diabetic macular edema in patients of type 2 diabetes mellitus Check the lipid profile and detail fundus examination of all patients included in study. Effect of lipid lowering agents (statin) on Diabetic retinopathy. Asses the changes in fundus of DME patients after giving statin. MATERIALS AND METHODS:- A prospective study was conducted in the OPD of upgraded department of ophthalmology at LLRM Medical College, Meerut over the duration of from July 2019 to June 2020. The proposed study was in association of status use and hyper triglyceridemia with diabetes macular edema in patients with type-2 diabetes and diabetic retinopathy. Clearance from institution ethics committee was obtained before the study was started. An informed consent was obtained from all the patients before including them in to the study. A total of 86 patients were divided in to two equal groups randomly RESULTS:- A prospective study was conducted in the OPD of upgraded department of ophthalmology at LLRM Medical College, Meerut over the duration of from July 2019 to June 2020 and sample size of patients taken was 86 About 70.9% of the patients in this study were males and 29.1% were females. About 26.7% of the study subjects in this study had diabetes mellitus since 16 – 20 years,25.6% since more than 20 years and 20.9% since 11 – 15 years. During the baseline the CSME in left eye was present in 24.4% of the cases and during follow up,the CSME was present in 10.5% of the cases . At the time of baseline,about 64% of the patients had no CSME in right eye and 36% had CSME.At the time of follow up 87.2% of the cases had no CSME and 12.8% had CSME. In mild NPDR during follow up,44.2% had mild NPDR,24.4% had moderate NPDR and 8.1% had severe NPDR at baseline. About17.4%ofthepatientswhohadmoderateNPDRatbaselinealsohadmoderateNPDRduringfollowupvisits inlefteye. Among all the patients with mild NPDR during follow up, 54.7% had mild NPDR, 22.1% had moderate NPDR and 10.5% had severe NPDR during baseline. About 12.8% who had moderate NPDR during baseline also had moderate NPDR during follow up in right eye Mean cholesterol level during baseline was 154.13 mg/dl and during follow up was 138.12 mg/dl which was statistically significant (p=0.000). The mean triglyceride level during the baseline was 178.37 mg/dl and during follow up was 156 mg/dl which was statistically significant between the two groups (p=0.000). Mean LDL cholesterol level during the baseline was 94.99 mg/dl and during follow up was 61.24 mg/dl which was statistically significant between baseline and follow up (p=0.000). This study had shown improvement of visual acuity,decrease in macular edema and progression of diabetic retinopathy. The study also revealed that ,the statins are effective in decreasing the total cholesterol, LDL cholesterol, and triglycerides. CONCLUSION:- This study had shown improvement of visual acuity,decrease in macular edema and progression of diabetic retinopathy in patients whom statins was given The study also revealed that,the statins are effective in decreasing the total cholesterol(mean value during baseline was 154.13 mg/dl which reduces to 138.12 mg/dl during follow up),LDL cholesterol (mean value reduces from 94.99 mg/dl during baseline to 61.24 mg/dl during follow up)and triglycerides (mean value during baseline 178.37 mg/dl to 156 mg/dl during follow up).as given.

Effect of pattern scanning laser on macular thickness in diabetic retinopathy.

Purpose:This study investigates the effect of pattern scanning laser (PASCAL) panretinal photocoagulation (PRP) on central macular thickness (CMT) and visual acuity (VA) in patients with proliferative diabetic retinopathy (PDR).Methods:This retrospective non-randomized comparative case series included 262 eyes (163 with macular edema) of 177 patients with PDR. Treatment was PRP alone (137), PRP + anti-vascular endothelial growth factor (VEGF) (69), PRP + focal laser (28), or all three (89). CMT and central macular volume 3 and 6 mm from fovea were analyzed before and 1, 3, and 6 months after PRP. Spot number was plotted against CMT, and linear regression analysis was performed.Results:For each treatment group and time point, there was a non-significant relationship between spot number and CMT. In eyes receiving all three treatment modalities, a significant negative relationship was found between spot number and 3-mm volume at 6 months (p = 0.04) and 6-mm volume at 1 month (p = 0.002) and 6 months (p = 0.011). There was no significant change in VA in any treatment group at the 6-month time point.Conclusion:PASCAL PRP ± focal laser or anti-VEGF was not associated with increased development of macular edema or change in VA. PASCAL PRP with focal laser and anti-VEGF may result in a decrease in macular edema.

Treatment of radiation-induced maculopathy with fluocinolone acetonide.

Chronic macular oedema is a well-known presentation of radiation-induced maculopathy (RM) following external beam photon therapy, plaque radiotherapy and proton beam radiotherapy for choroidal tumours. Current therapies vary in respect of efficacy and clinical benefit. The potential of fluocinolone acetonide (FAc) slow-release implants is unknown. We hypothesised that local continuous delivery of low-dose corticosteroids might improve symptoms of RM. Five-two male and three female-patients from 37 to 68years presented with RM following 106Ru-plaque brachytherapy or stereotactic radiation therapy (STx) with photons using a hypofractionated schedule of 5 × 10Gy. All were treated with triamcinolone injections in first line and proofed to be refractory to steroids. In addition, two patients had received Ozurdex® implants as a second-line treatment, though without any clinical benefit. FAc slow-release implants were injected, and patients were followed up to monitor clinical improvement. All patients responded to therapy by means of a decrease in macular oedema. In four of five (80%) patients, visual acuity improved, and one patient showed stable visual acuity. No toxic effects or complications were observed. Slow-release implants of FAc are a promising therapeutic potent steroid treatment option to benefit anatomical structures of the fovea and visual function. Slow-release implants with FAc reduce the frequency of intravitreal injections and the therapeutic burden.

Микроимпульсная циклофотокоагуляция в комбинированном лечении неоваскулярной глаукомы

Introduction. Neovascular glaucoma (NVG) is one of the most prognostically unfavorable forms of the glaucomatous process. The leading pathogenetic mechanism for the development of NVH is hypoxia of the inner layers of the retina, leading to the development of endothelial vascular growth factors (VEGF), which induce neovascular proliferation. In the presence of newly formed vessels in the corner of the anterior chamber, the use of traditional surgical methods for treating glaucoma is limited. That is why the search for a new pathogenetically oriented methods for the treatment of NVH is still acute issue in ophthalmology. Purpose. To evaluate the preliminary results of combined treatment, including intraocular introduction of anti-VEGF therapies (ranibizumab) and micropulse cyclophotocoagulation, in patients with secondary neovascular glaucoma. Materials and methods. The study included 15 patients (15 eyes) with secondary neovascular glaucoma. The value of intraocular pressure (IOP) before surgery ranged from 28 to 44 mm Hg. (average 36.3 ± 4.4 mm Hg), the number of hypotensive drops was 3.5 ± 0.5. The combine treat of patients including the intraocular administration of a VEGF inhibitor (ranibizumab) and through 7-14 days transscleral diode-laser cyclophotocoagulation in micropulse mode on the device «Cyclo G6 Glaucoma Laser System» (IRIDEX, USA) with a laser power of 2000 mW, an exposition of 160 s (80 s in each hemisphere) and a duty cycle of 31.3%. Results. All treatment procedures were performed without complications. By 6 months of follow-up, the average IOP level was 26.9 ± 3.3 mm Hg, the number of hypotensive drops was reduced to 2.7 ± 0.7 drugs. By 1 month of observation, a decrease in the number of newly formed vessels of the iris was achived in all patients. According to ultrasound biomicroscopy, the thickness of the ciliary body (CT) before treatment was on average 0.58 ± 0.14 mm. By 6 months of follow-up, no cases of postoperative atrophy of CT was diagnosed, the thickness of the CT was on average 0.53 ± 0.11 mm. According to the data of optical coherence tomography in the angiography mode, in all cases there was a positive dynamic in 1 month after combined treatment - a significant decrease in macular edema, the area of the retinal nonperfusion zone and the number of newly formed vessels. Conclusion. Combined treatment of patients with secondary neovascular glaucoma, including intraocular introduction of anti-VEGF therapies and micropulse cyclophotocoagulation, is an effective and safe method for reducing IOP.

Prospective study of intravitreal triamcinolone acetonide versus bevacizumab with or without laser for macular edema secondary to retinal vein occlusion

Objective: To assess difference in visual outcome, macular thickness and need for laser treatment in patients receiving intravitreal triamcinolone acetonide or bevacizumab for macular oedema secondary to retinal vein occlusion. Design: Open labeled prospective randomised controlled trial, evaluating 38 retinal vein occlusion patients. 19 patients each were assigned, to Intravitreal Triamcinolone Acetonide (IVTA) and Bevacizumab (IVB) group. Methodology: Baseline ocular parameters like best corrected visual acuity (BCVA), intraocular pressure (IOP) by Applanation tonometry, fundus examination using indirect ophthalmoscope, slit lamp biomicroscopy, Ocular Coherence Tomography of the macula and Fundus Flourescein Angiography performed. Under aseptic conditions, Injection of 4 mg (0.1 ml) Triamcinolone Acetonide (Kenacort) or 1.25 mg (0.05 ml) Bevacizumab (Avastin) was injected into the vitreous. Patients were given re-injections or laser treatment according to requirement. BCVA and IOP at 15 days, 1, 3 and 6 months post injection was recorded. OCT and FFA were repeated at 3 and 6 month. Outcome: At 6 months, patients with BRVO receiving IVTA, there was significant improvement in visual acuity (p = 0.014), as well as decrease in macular edema (p ≈ 0.000), whereas patients of BRVO in the IVB group did not show significant improvement in visual acuity (p= 0.375). Visual acuity of CRVO patients in the IVTA (p = 0.178) and IVB (p = 0.109) group did not show any significant improvement. Though there was significant decrease in macular edema in both IVTA (p ≈ 0.000) and IVB (p =0.042) groups. No significant increase in IOP was noted in either IVTA (p= 0.089) or IVB (p = o.637).Results and Conclusion: The results show a favourable influence of IVTA on BCVA at 6 months.Positive effect in decreasing central macular thickness (CMT) was observed in patients receiving IVTA and IVB.FFA guided laser photocoagulation helps in stabilizing the visual acuity and prevents vision threatening complications. Changes in OCT can be used to monitor patient response to treatments for CRVO related macular oedema. Summary: IVTA injection when combined with FFA guided laser in BRVO eyes showed most favourable outcome in terms of both visual improvement and CMT during follow up period of 6 months.

INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS FOR EXUDATIVE RETINAL ARTERIAL MACROANEURYSMS.

There is no established therapy for exudative-hemorrhagic complications in primary retinal arteriolar macroaneurysm (RAM). Retrospective multicenter interventional study of anti-vascular endothelial growth factor in symptomatic RAMs. Central macular thickness in μm and best-corrected visual acuity in logMar were correlated with the RAM size and distance to the macula. Statistical analyses were performed using paired comparisons and Pearson correlation. Thirty-two eyes (32 patients) were treated with a mean of 2.7 injections over a mean follow-up of 16.6 months. Initial best-corrected visual acuity correlated with the RAM size and distance to the macula (P = 0.02). Central macular thickness decreased by 131,180, and 211 μm at 1, 2, and 3 months after the first injection (P < 0.001). Best-corrected visual acuity improved by 0.47 and 0.38 Early Treatment Diabetic Retinopathy Study lines at 2 and 3 months (P = 0.005). Anti-vascular endothelial growth factor response correlated with the RAM size (P = 0.04) and the distance to the macula (P = 0.009). Symptomatic RAMs can be treated successfully with anti-vascular endothelial growth factor injections, leading to a decrease in macular edema.

Slow progression of exudative age related macular degeneration associated with hypertrophy of the retinal pigment epithelium.

Choroidal neovascular (CNV) lesions in younger patients are often accompanied by the appearance of a surrounding ring of pigment that is associated with disease regression or slowed disease progression. In older patients with age-related macular degeneration (AMD), however, hypertrophy of the retinal pigment epithelium (RPE) is known to occur but has not previously been reported to be associated with CNV regression. This report describes the clinical course of a case series of AMD patients with pigment hypertrophy adjacent to CNV associated with stabilization of the CNV lesion. A retrospective analysis of exudative AMD patients seen by a single retina specialist over a 7-year period. Retrospective analysis of 955 exudative AMD patients revealed pigment hypertrophy associated with CNV in 33 patients. A ring of pigment surrounded CNV in 6 of these. Three representative patients are presented to illustrate the decrease in macular edema, reduced fluorescein leakage and slowed CNV progression that was associated with a pigment ring around CNV in AMD. Pigment hypertrophy was associated with blocked fluorescein leakage and exudative AMD patients with a complete pigment ring maintained stable visual acuity, macular edema, fluorescein leakage and CNV lesion size without treatment for intervals of up to 21 months. We report slowed disease progression in AMD patients who develop pigment around CNV. The slow rate of disease progression in the AMD patient subgroup having a pigment ring is a factor to consider in determining the treatment interval for exudative AMD patients.

Neuroretinitis por Bartonella henselae: a propósito de un caso con seguimiento por tomografía de coherencia óptica

The case of a 36 year-old male with neuroretinitis caused by Bartonella henselae is reported, whose periodic follow-up was done through optical coherence tomography (OCT). The onset of this disease was characterized by unilateral low visual acuity (VA), painless, of sudden onset, in the right eye (RE), associated to l febrile symptom. The funduscopic examination showed edema in the posterior pole which extended from the optical disc to the macular region in the RE. The OCT confirmed macular and optical disc thickening, as well as the presence of subretinal macular fluid. Systemic studies were normal except for a blood count due to the presence of leukocytosis and positive for Bartonella henselae. The follow up with CT Scan helped to evaluate the decrease in macular edema, with the subsequent improvement of visual acuity and absence of related complications. This report describes the utility of the follow up with OCT in a patient with neuroretinitis caused by Bartonella henselae.

Evaluation of mean retinal sensitivity using MP‑1 microperimeter in patients with diabetic macular edema before and after laser photocoagulation treatment

Diabetic macular edema (DME) is a common cause of visual acuity deterioration among patients with diabetes. Laser photocoagulation still remains the most common treatment of DME and diabetic retinopathy. The aim of the study was to assess mean central retinal sensitivity among patients with DME before and after laser photocoagulation treatment. Additionally, we estimated the best-corrected visual acuity (BCVA) and retinal macular thickness before and after treatment. The study included 30 patients (35 eyes with DME). The mean age was 61.9 ±4.8 years. Insulin was administered in 22 patients and oral antidiabetics in 8. Laser photocoagulation in the macular area was performed in all patients using the Pascal laser. We measured the BCVA, mean central retinal sensitivity, and retinal thickness in the macula (divided into 9 segments). The measurements were performed before and at 1, 3, and 6 months after laser treatment. Central retinal sensitivity was assessed with the MP-1 microperimeter and macular thickness with optical coherence tomography (Stratus OCT). The statistical analysis did not reveal significant differences between BCVA and central retinal sensitivity in the study group before and after laser treatment. The analysis of the mean central retinal thickness showed a significant decrease in macular edema in the individual segments at 1, 3, and 6 months after photocoagulation. Photocoagulation of DME with the Pascal laser did not cause significant changes either in the BCVA or central retinal sensitivity. Laser treatment in patients with DME significantly reduced central retinal edema in most segments.

Diabetic macular oedema: physical, physiological and molecular factors contribute to this pathological process

Diabetic macular oedema (DMO) is an important cause of vision loss in patients with diabetes mellitus. The underlying mechanisms of DMO, on both macrocellular and microcellular levels, are discussed in this review. The pathophysiology of DMO can be described as a process whereby hyperglycaemia leads to overlapping and inter-related pathways that play a role not only in the initial vascular events, but also in the continued tissue insult that leads to chronic DMO. On a macrocellular level, DMO is believed to be in part caused by alterations in hydrostatic pressure, oxygen tension, oncotic pressure and shear stress. Three key components of the microvascular pathways include angiogenic factor expression, inflammation and oxidative stress. These molecular mediators, acting in conjunction with macrocellular factors, which are all stimulated in part by the hyperglycaemia and hypoxia, can have a direct endothelial effect leading to hyperpermeability, disruption of vascular endothelial cell junctions, and leukostasis. The interactions, signalling events and feedback loops between the various molecules are complicated and are not completely understood. However, by attempting to understand the pathways involved in DMO, we can help guide new treatment options targeted towards specific factors or mediators.

Continuous anti-VEGF treatment with ranibizumab for polypoidal choroidal vasculopathy: 6-month results

AimTo evaluate the short-term efficacy and safety of monthly intravitreal injections of ranibizumab in patients with polypoidal choroidal vasculopathy (PCV) and active exudation or haemorrhage.MethodsA prospective, open-label trial of monthly...

Enzymatic Vitreolysis

In the absence of posterior vitreous detachment, vitreous cortex is adhered to the internal limiting lamina of the inner retina. This junction between the vitreous and the retina is thought to participate in the pathophysiology of diverse retinal diseases, including proliferative diabetic retinopathy and diabetic macular edema. Vitrectomy has been associated with decrease of macular edema and improvement of visual acuity in eyes of diabetic patients. Thus, many pharmacologic agents have been studied with the aim of inducing a posterior vitreous detachment in order to facilitate the surgical procedure and reduce complications of vitrectomy. More recently, different agents such as plasmin and microplasmin have shown to be able to induce a posterior vitreous detachment given as a single intravitreal injection. The aim of this article is to give a scope about the pharmacologic vitreolysis and posterior vitreous detachment studies and describe some ongoing clinical trials that will determine the efficacy and safety of these novel therapies for diabetic retinopathy.

Early intravitreal bevacizumab for non‐ischaemic central retinal vein occlusion

To evaluate the effect of early intravitreal bevacizumab injections for the treatment of macular oedema caused by non-ischaemic central retinal vein occlusion (CRVO). The study included 25 patients (25 eyes) with macular oedema caused by non-ischaemic central retinal vein occlusion, who received three intravitreal injections of 1.5 mg bevacizumab with an interval of 6 weeks between the injections. Mean duration of central retinal vein occlusion prior to the first injection was 4.2 +/- 3.6 days. All patients were re-examined 1, 3 and 6 months after the first injection. The main outcome parameters were visual acuity and macular thickness, as measured by optical coherence tomography. Mean visual acuity improved significantly from 0.97 +/- 0.40 logMAR at baseline to 0.70 +/- 0.42 logMAR (P = 0.007) at 1 month, 0.69 +/- 0.46 (P = 0.006) 3 months and 0.69 +/- 0.52 (P = 0.015) 6 months after the first injection. Mean central retinal thickness decreased significantly from 530 +/- 152 microm at baseline to 347 +/- 127 microm (P < 0.001) at 1 month, 370 +/- 165 microm (P < 0.001) 3 months and 346 +/- 129 microm (P < 0.001) 6 months (P < 0.001) after the first injection. The increase in visual acuity correlated significantly (P < 0.01) with the decrease in macular thickness. Mean intraocular pressure was 14.2 +/- 3.2 mmHg at baseline and did not differ significantly from the measurement obtained at 1 month (P = 0.59), 3 months (P = 0.88) and 6 months after the first injection (P = 0.65). Intravitreal bevacizumab injections given shortly after onset of non-ischaemic central retinal vein occlusion may result in a significant increase in vision and a corresponding decrease in macular oedema.

Traitement chirurgical de l’œdème maculaire persistant des occlusions veineuses rétiniennes

Persistent macular edema (ME) is the main cause of poor visual outcome in nonischemic retinal vein occlusion (RVO). The aim of this study was to evaluate the results of surgery in this disorder. Retrospective nonrandomized comparative pilot study. Visual acuity measurement, fluorescein angiography, and optical coherence tomography were performed before and after treatment, at 3 months, 6 months, and 1 year. The study included 42 eyes: 15 eyes underwent vitrectomy with peeling of the posterior hyaloid and/or the internal limiting membrane, 19 received intravitreous injection of triamcinolone (IVT), and four had a combination of both treatments. In the vitrectomy group, 63% of the eyes showed a progressive decrease of ME throughout the year of follow-up (p<0.05 at 1 month and 1 year) and an increase in visual acuity (p<0.05 at 3 and 6 months); no complication occurred. In the IVT group, the eyes showed a rapid improvement in vision and in ME at 1 month (p=0.007 and p=0.001, respectively) but with a frequent ME recurrence at 4 months; however, 31% of eyes showed durable improvement. Complications after IVT were pseudo-endophthalmitis (one eye), transient hypertony (53%), and a full-thickness macular hole (one eye). In the group treated with vitrectomy combined with IVT, ME decreased rapidly and durably, but vision did not improve in this small subgroup of long-lasting RVO with prior pigment epithelial changes. In some eyes, vitrectomy seems to have a more durable effect than IVT alone. Further randomized and controlled studies are needed to confirm these results and to compare them to the natural course of the disease.

Prospective optical coherence tomographic evaluation of the efficacy of oral and posterior subtenon corticosteroids in patients with intermediate uveitis

To prospectively evaluate the efficacy of oral corticosteroids and posterior subtenon injection in the treatment of macular edema in patients with intermediate uveitis using optical coherence tomography (OCT). Twenty-two patients with intermediate uveitis were treated with posterior subtenon injection when the disease was unilateral (group A, n=11) or with oral steroids when the disease was bilateral (group B, n=11). Changes in macular thickness from baseline was determined using OCT in both groups at day 0, day 3, day 14, 6 weeks and 12 weeks. Statistically significant improvement in Snellen visual acuity in group A was seen at 6 weeks and in group B at 2 weeks. In patients receiving oral corticosteroids, foveal thickness decreased by 63% by day 3. In those treated with posterior subtenon injection, even at day 14 only a 55% reduction of foveal thickness was evident. Spearman's correlation coefficient for visual acuity and foveal thickness was found to be significant. OCT confirms a significantly more rapid decrease in macular edema in patients treated with oral corticosteroids. A short course of oral steroids may be useful in enabling earlier visual recovery in patients treated with posterior subtenon injection for unilateral uveitic macular edema.

INTRAVITREAL BEVACIZUMAB (AVASTIN) TREATMENT OF MACULAR EDEMA IN CENTRAL RETINAL VEIN OCCLUSION

To report the short term anatomic and visual acuity response after intravitreal injection of bevacizumab (Avastin, Genentech) in patients with macular edema due to central retinal vein occlusion (CRVO). The authors conducted a retrospective study of patients with macular edema due to CRVO who were treated with at least one intravitreal injection of bevacizumab 1.25 mg in 0.05 mL. Patients underwent Snellen visual acuity testing, optical coherence tomography (OCT) imaging, and ophthalmoscopic examination at baseline and follow-up visits. There were 16 eyes of 15 consecutive patients with a mean age of 76.1 years (SD 9.8 years). Intravitreal triamcinolone had been previously administered to 9 patients, but all of these patients either had no improvement or had excessive intraocular pressure caused by the triamcinolone. The patients received a mean of 2.8 injections of bevacizumab per eye. No adverse events were observed, including endophthalmitis, clinically evident inflammation, increased intraocular pressure, retinal tears, retinal detachment, or thromboembolic events in any patient. The mean central macular thickness at baseline was 887 microm and decreased to a mean of 372 microm at month 1 (P < 0.001). The mean baseline acuity was 20/600 (logMAR = 1.48) and the mean acuity at month 1 was 20/200 (logMAR = 1.05), a difference that was highly significant (P = 0.001). At last follow-up, a mean of 3 months after the first injection, the mean visual acuity was 20/138 (logMAR = 0.84), which was significantly better than baseline (P < 0.001). Visual acuity improvement, defined as a halving of the visual angle, was seen in 14 of the 16 eyes. Initial treatment results of patients with macular edema secondary to CRVO did not reveal any short-term safety concerns. Intravitreal bevacizumab resulted in a significant decrease in macular edema and improvement in visual acuity. The number of patients in this pilot study was limited and the follow-up is too short to make any specific treatment recommendations, but the favorable short-term results suggest further study is needed.

Facteurs de risque de l’œdème maculaire diabétique

To determine the risk factors involved in the development of macular edema. A retrospective, case-control study conducted on 200 diabetic patients with diabetic retinopathy: 100 patients with macular edema and 100 control patients. All patients were examined using slit-lamp biomicroscopy completed by fluorescein angiography. A physical examination and the appropriate biological investigations were also carried out. Statistical significance was determined by the chi square test and Fisher's exact test. A value of p<0.05 was considered statistically significant. The incidence of macular edema was significantly associated with longer duration of diabetes, a higher level of glycemia, the type of diabetes in the older onset group using insulin, the severity of diabetic retinopathy at baseline, and old age. Panretinal photocoagulation was also found as a risk factor for macular edema. These data suggest that laser photocoagulation, reduction of hyperglycemia and better control of other factors may result in a beneficial decrease in macular edema.