Diffuse Macular Edema Research Articles

Prevalence, clinical characteristics, and independent predictors of uveitic macular edema in an Asian population: a retrospective cohort study

BackgroundTo determine the prevalence, clinical characteristics, and independent predictors of uveitic macular edema (UME) in patients with intermediate, posterior and panuveitis.MethodsWe retrospectively reviewed the records of patients with intermediate, posterior, and panuveitis who underwent macular assessment using optical coherence tomography between January 2015 and February 2020. The prevalence of UME and clinical characteristics of the patients were described. Predictors of UME were identified using multivariate regression analysis.ResultsA total of 349 patients were included. The mean age was 41 years, female: male ratio was 1.3:1. The prevalence of UME was 51.9%. UME was found in 33.9%, 56.9%, and 54.1% of the intermediate, posterior, and panuveitis cases, respectively. Among patients with UME, 47% had infectious uveitis, 32.6% had idiopathic uveitis, and 20.4% had immune-mediated uveitis. Diffuse macular edema was the most frequently observed pattern (36.5%). Multivariate analysis showed that factors independently associated with UME included age at uveitis onset (adjusted odds ratio [aOR] 1.01, 95% confidence interval [CI] 1.00-1.03, P = 0.036), PU and panuveitis compared with intermediate uveitis (aOR 2.09, 95% CI 1.14–3.86, P = 0.018), and infectious uveitis compared with noninfectious uveitis (aOR 2.13, 95% CI 1.34–3.37, P = 0.001).ConclusionsIncreasing age at uveitis onset, posterior/panuveitis, and infectious etiology are predictive factors for UME in patients with intermediate, posterior and panuveitis.

Patterns of Macular Edema in Branch Retinal Vein Occlusion Diagnosed by Optical Coherence Tomography.

Branch Retinal vein occlusion is the most common retinal vascular disease after diabetic retinopathy in elderly populations. To describe morphological patterns of macular edema in branch retinal vein occlusion using optical coherence tomography. It is a hospital based; descriptive, cross-sectional study. All patients with macular edema secondary to branch retinal vein occlusion diagnosed by optical coherence tomography and fulfilling the inclusion criteria from 2017 July 1 to 2018 July 1 were studied. A total of 84 eyes of 84 patients were enrolled. The mean age of the patient was 68.0833 ± 11.22 years (range, 35-74 years). Forty-five (53.57%) were male. Forty-four eyes had right eye involvement. Major and macular branch retinal vein occlusion was found in 50 and 34 eyes respectively. Forty eight eyes had superior and 36 eyes had inferior branch retinal vein occlusion. Morphological patterns of macular edema were classified: cystoid macular edema, cystoid macular edema with serous retinal detachment, diffuse macular edema and diffuse macular edema with serous retinal detachment of which 68 (80.95%) had cystoid macular edema. Out of 84 eyes, 30 (35.71%) had inner and outer segment (IS/OS) junction disruption. Optical coherence tomography is a safe and noninvasive technique. Serous retinal detachment and photoreceptors disruption may go unnoticed unless OCT is performed. It can measure the changes in retinal thickness and thus predict the visual outcomes in patients with macular edema.

Are optical coherence tomography and fluorescein angiography comparable for detection of macular edema in Behçet uveitis?

To investigate the role and agreement of spectral domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) for macular edema (ME) diagnosis in Behçet uveitis (BU). Eyes with ME detected by SD-OCT and/or FA were enrolled. Type of ME by SD-OCT and grade of macular leakage (ML) by FA were investigated. Eyes were divided into three groups according to the agreement of tests. Three groups and factors that could affect the compatibility of tests were statistically analyzed. Sixty-one eyes of 61 patients were included. Both imaging methods detected ME in 42.6% of eyes (group 1). In 47.5% of eyes, ME was revealed by OCT (group 2). The remaining 9.8% of the eyes had ME, detected only by FA (group 3). Grade 2 ML by FA was more common in group 1 (p = 0.01). The grade of ML by FA was similar in groups 2 and 3. In group 2, most of the eyes showed diffuse ME by OCT (p < 0.001). Epiretinal membrane was detected more frequently in group 3 (p = 0.005). Duration and activity of uveitis were similar between groups. SD-OCT was able to detect ME in 90% of the eyes with BU. Duration and activity of uveitis were not related to the compatibility of imaging methods.

Optical Coherence Tomography: Focus on the Pathology of Macula in Scleritis Patients.

Twenty-four patients diagnosed with scleritis were selected for this study. All of the patients went through basic ophthalmological examinations, such as visual acuity testing (VA), intraocular pressure measurement (IOP), slit lamp examination, ophthalmoscopic examination, and OCT. OCT examinations were taken by SD-OCT Spectralis OCT system (Heidelberg Engineering, Heidelberg, Germany). Twenty-seven eyes of 24 patients (7 males and 17 females) were included in this study, who were diagnosed with scleritis. OCT examinations showed epiretinal membrane (ERM) in three patients (12%), cystoid macular edema (CME) (three cases, 12%), diffuse macular edema (DME) (one case, 4%), and serous retinal detachment (SRD) (one case, 4%). OCT proved to be a valuable, non-invasive method for detecting macular pathology in patients with scleritis. Despite the best treatment regimen applied, macular involvement resulting in reduced visual acuity (VA) can develop, which we could detect with OCT since macular edema (ME) is the leading cause of decreased vision due to the damaged outer blood-retina barrier (BRB) in inflammation. OCT investigation is a highly important method for early detection of ocular complications in scleritis in order to prevent blindness.

Correlation between Morphological Characteristics of Macular Edema and Visual Acuity in Young Patients with Idiopathic Intermediate Uveitis.

Background and Objectives: Macular edema (ME) is a common complication of intermediate uveitis (IU). It is often responsible for a decrease in visual acuity (VA). Three distinct patterns of macular edema have been described in intermediate uveitis, namely, cystoid macular edema (CME), diffuse macular edema (DME), and serous retinal detachment (SRD). The current study aims to describe the characteristics of macular edema in young patients with idiopathic intermediate uveitis and to correlate its features with VA using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: A total of 27 eyes from 18 patients with idiopathic IU complicated by ME were included in this retrospective study. All patients underwent SD-OCT; data were gathered at the onset of ME. Best-corrected VA (BCVA) was correlated with the morphological features of ME. Results: BCVA was negatively correlated with Ellipsoid Zone (EZ) disruption (p = 0.00021), cystoid pattern (p = 0.00021), central subfield thickness (CST) (p < 0.001), and serous retinal detachment (0.037). Conclusions: In ME secondary to idiopathic IU, VA negatively correlates with Ellipsoid Zone disruption and increases in CST. Moreover, vision is influenced by the presence of cysts in the inner nuclear and outer nuclear layers and by the neuroepithelium detachment.

Choroidal Thickness in Different Patterns of Diabetic Macular Edema.

This observational study investigated the changes in choroidal thickness (ChT) in different patterns of diabetic macular edema (DME) based on image processing using enhanced-depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT). Participants with ocular conditions affecting the fundus view, including retinal diseases, were excluded. After observing the patient’s medical record, multicolor fundus photos, thickness maps, and subtypes of DME were diagnosed according to the criteria reported by the Early Treatment Diabetic Retinopathy Study (ETDRS). Edema was classified as focal or diffuse and was subdivided into cystic macular edema (CME), CME with subretinal fluid (CME+), and spongy macular edema (SME). Image processing was performed on the B-scan images from SD-OCT to segment the choroid layer and obtain the choroid thickness. A total of 159 eyes of 81 patients (46 males and 35 females; 57.53 ± 9.78 years of age), and 57 eyes of 30 healthy individuals (age 57.34 ± 8.76 years) were enrolled in this study. Out of 159 eyes, 76 had focal macular edema (FME), 13 exhibited SME, and 51 presented CME. Among those with cystic macular edema, 19 eyes showed subretinal fluid (CME+). The average choroidal thickness in FME, diffuse SME, CME, and CME+ was 216.95 ± 52.94 µm, 243.00 ± 46.34 µm, 221.38 ± 60.78 µm, and 249.63 ± 53.90 µm, respectively. The average choroidal thickness in age-matched controls was 213.88 ± 45.60 µm. Choroidal thickness increases with the severity of edema; choroidal thickness was higher in diffuse macular edema than in FME. However, choroidal thickness increased in cystic macular edema with subretinal fluid (CME+).

English

BACKGROUND Screening of Diabetic retinopathy is essential for detection of diabetic retinopathy and its management. Diabetic retinopathy is a common and preventable cause of blindness in adults. Laser pan-retinal photocoagulation has been proven to have established efficacy in treating diabetic visual loss. Since India has a wide geographical area and there is a lack of trained ophthalmologists in peripheral India, there is an immense need for telemedicine in diabetic retinopathy screening. This study was done to evaluate the comparability of non-stereoscopic fundus photography with conventional fundoscopy for detection of diabetic maculopathy. METHODS All patients with diabetic retinopathy and mixed retinopathy presenting to Ophthalmology OPD at Sri Siddhartha Medical College between June 2020 and June 2021, were included in the study. The patients were evaluated for visual acuity on Snellen Visual Acuity Chart, Anterior Segment evaluation on a slit-lamp examination. Fundus was evaluated with 90 Diopter Volk lens with Slit Lamp biomicroscopy, Direct Ophthalmoscopy with Welch Allyn ophthalmoscope with medium size aperture, and the peripheral fundus was seen by an Indirect Ophthalmoscope with 20 Diopter lens Volk lens. ETDRS 7 Field Picture on Carl Zeiss Meditec AG VISUCAM SN model AA107 was taken. The observations were subjected to the statistical analysis of Cohen’s Kappa and the percentile description. RESULTS The commonest retinopathy was moderate non-proliferative diabetic retinopathy (NPDR), seen in 41.667 %. The commonest maculopathy found was the absence of maculopathy seen in 78.3 % of cases. There was perfect agreement (Kappa k-1.00) in the evaluation of background retinopathy on Conventional Fundoscopy and Fundus imaging, P-value &lt; 0.001. There was moderate agreement (Kappa k-0.5) in the evaluation of maculopathy on Conventional Fundoscopy and Fundus imaging, Pvalue &lt; 0.001, only for CSME and No maculopathy. However diffuse macular oedema and Ischemic Maculopathy were missed on Fundus Photography. CONCLUSIONS Non-Stereoscopic Fundus Photography is a good telemedicine tool for diabetic retinopathy screening, but there is under-diagnosis of it, though it can detect diabetic maculopathy. As a diagnosis”Absence of maculopathy” is inconclusive until and unless screened by Conventional Ophthalmoscopy. KEY WORDS Diabetic Retinopathy, Maculopathy, Clinically Significant Macular Oedema, NonStereoscopic Fundus Imaging, Ophthalmoscopy.

Spectral domain optical coherence tomography findings of patients with pars planitis and risk factors affecting visual acuity.

To evaluate spectral domain optical coherence tomography (SD-OCT) findings of 42 eyes with pars planitis and to identify risk factors affecting visual acuity. Medical records and SD-OCT findings were retrospectively reviewed. Mean best-corrected visual acuity (BCVA) was 0.248 ± 0.3 on the logMAR scale at baseline. SD-OCT findings included epiretinal membrane (ERM) in 16 (38.1%) eyes, loss of normal foveal contour appearance in 8 (19.0%), ellipsoid zone (EZ) damage in 5 (11.9%), external limiting membrane (ELM) damage in 3 (7.1%), disruption of retinal pigment epithelium (RPE) in 2 (4.8%), and macular atrophy in 1 (2.4%). There was macular edema in 10 (23.8%) eyes [cystoid macular edema (CME) in 8 (19.0%), diffuse macular edema (DME) in 6 (14.3%), and serous retinal detachment in 2 (4.8%)]. The mean central macular thickness (CMT) was 272.1 ± 319.5μm. Patients were followed up for a mean of 50.6 ± 36.7months. Mean BCVA was 0.210 ± 0.3 at the final evaluation. SD-OCT findings included ERM in 28 (66.7%) eyes, EZ damage in 6 (14.3%), ELM damage in 3 (7.1%), disruption of RPE in 4 (9.5%), loss of normal foveal contour appearance in 12 (28.6%), and macular atrophy in 2 (4.8%). There was CME and/or DME in 6 (14.3%) eyes. The mean CMT was 238 ± 220.9μm and was significantly lower than the baseline (p < 0.001). According to multivariate linear regression analysis, the presence of DME, and loss of normal foveal contour appearance at baseline were the independent factors associated with BCVA at the final examination (B = 0.726, p < 0.001; B = 0.766, p < 0.001, respectively). DME and loss of normal foveal contour appearance were more likely to have adverse effects on visual acuity.

OPTICAL COHERENT TOMOGRAPHY IN DIAGNOSIS OF ACUTE DISORDERS OF VENOUS BLOOD CIRCULATION IN THE RETINA AND THEIR COMPLICATIONS

A comprehensive ophthalmological examination of patients with acute disorders of venous blood circulation in the retina was carried out using a new, modern, non-contact and highly accurate method of diagnosing ophthalmological diseases – optical coherent tomography. The features of optical coherent tomography in patients with different types of acute disorders of venous blood circulation in the retina are described.&#x0D; Comprehensive examination of such patients using traditional ophthalmological methods, biomicroophthalmoscopy, retinal photography using a fundus camera, fluorescent angiography, optical coherent tomography provides early diagnosis of macular edema and ischemic retinal zones.&#x0D; We examined 62 patients with retinal vein occlusion. Ischemic type of retinal vein occlusion was diagnosed in 30 patients and non-ischemic type in 32 patients.&#x0D; The average age of patients with ischemic thrombosis was 63.5 years. The initial visual acuity of the affected eye patients was low: 0.01-0.05 (20 patients with ischemic thrombosis) and 0.05-0.1 (10 patients with ischemic thrombosis) depending on the lesion of the macular retina zone.&#x0D; On fluorescent angiograms of patients with ischemic retinal central vein thrombosis, there was a considerable elongation of retinal circulation time, asymmetry in contrasting the branches of the retinal central vein. The main sign of ischemic thrombosis was extensive hypo- and non-fluorescence retinal regions. In the later phases, hyperfluorescence of the optic disc and the macular region were recorded.&#x0D; In patients with ischemic type of acute disorders of venous circulation in the retina, a thickening of the retina is detected on the optical coherent tomography, mainly due to diffuse and cystic macular edema, as well as exudative detachment of the neuroepithelium. Retinal thinning areas on optical coherent tomography responded to areas of capillary neperfusion.&#x0D; The average age of non-ischemic thrombosis patients was 59.2 years. Non-ischemic thrombosis patients showed relatively high visual acuity. Initial visual acuity of 0.3 and above was found in 23 patients with non-ischemic thrombosis; 0.1 - 0.3 - in 5 patients; less than 0.1 - in 4 patients. Macular edema was one of the main reasons for the significant loss of vision in such patients.&#x0D; On fluorescent angiograms of non-ischemic thrombosis patients, an increase in the time of venous perfusion was recorded, the time of contrasting arteries was in line with normal indicators. In the arterial-venous phase, hyperfluorescence of retinal veins, extraction of large vessels, dilation of capillaries and veins were detected. A hyperfluorescence of the optic disc, the macular region of the retina, has been detected as a result of edema of optic disc and the macular region of the retina. There were no areas of long capillary neperfusion and no signs of retinal neovascularization in non-ischemic thrombosis patients.&#x0D; We have not found extensive areas of retinal thinning in patients with non-ischemic type of acute disorders of venous circulation in retina on optical coherent tomography. A slight thickening of the macular region with no change in retinal architecture has been detected in 5 patients with non-dischemical type of thrombosis&#x0D; This approach makes it possible to predict the course of the disease and to prescribe appropriate treatment to prevent the neovascularization of the retina and the possible development of secondary neovascular glaucoma.

A study on laser photocoagulation in diabetic macular edema: Assessment with optical coherence tomography

Introduction: Diabetic macular edema (DME) is the most common cause of visual loss among diabetic patients. Macular photocoagulation is the established mode of treatment for clinically significant macular edema (CSME). Objective: This study was conducted to know the response of focal and diffuse diabetic edema separately to frequency doubled Nd:YAG. Materials and Methods: A prospective study with total of 30 consecutive eyes with Clinically Significant Macular Edema (CSME) over 8 months in our institution and divided into two groups with 15 each as focal and diffuse on the basis of fundus bio-microscopy and fluorescein angiography. Baseline measurements were done by OCT. Patients with diffuse diabetic macular edema underwent modified grid laser photocoagulation with Frequency Doubled Nd: YAG. Patients of focal diabetic macular edema underwent focal photocoagulation with Frequency Doubled Nd: YAG. Patients were followed up at 4 weeks and 12 weeks with repeat measurements by OCT with Humphrey Zeiss Stratus 3.0. Data entered in excel sheet and analyzed using SPSS software. The demographical data was analyzed with descriptive and the correlations by Pearson correlation. Results: Among 15 eyes with focal macular edema mean age of patients was 59.80 ± 5.13 years whereas among diffuse macular edema, it was 67.80 ± 3.76 years. In the focal group, the mean BCVA letter score did not reveal a significant change at 4 and 12 weeks compared with the baseline (p=0.52 and p=0.74, respectively). In the diffuse group, the mean BCVA letter score showed a gradual decrease at 4 weeks and increased at 12 weeks compared with the baseline however this was not statistically significant. When central foveal thickness, perifoveal thickness, maximum retinal thickness and total macular volume were compared at baseline, 4 weeks and 12 weeks after surgery, it was found that visual outcome was better after laser photocoagulation in CSME when assessed using OCT. Conclusion: Laser photocoagulation

Efficacy of optical coherence tomography and fundus fluorescein angiography in detection of diabetic macular edema

Purpose: Significance of clinical DME in an up becoming capital nation of diabetes mellitus in world has socio-economic effect due to VTDR is identified as the major cause of irreversible blindness in DR subjects in all age groups. Therefore, the need for reliable, safe and immediate detection of DME is a need for prevention of the disease & related socio economic burden. The study was to compare the diagnostic potential of two commonly established diagnostic instruments i.e.-SD-OCT & FFA for the detection of DME. Materials and Methods: A prospective study with purposively sampling technique was carried on 308 eyes of 154 type II DM patients to compare the detection potential between two popular retinal diagnostic techniques, SD-OCT a non-invasive technique versus FFA invasive method for DME. The standard parameters such as focal macular edema, diffuse macular edema and mixed edema with cystoid type were evaluated with FFA. Subsequently DME classification with presence of intraretinal edema, sub retinal fluid and mixed edema were diagnosed with SD-OCT for the same pool of patients. Clinical features in DME using reference ‘EDTRS’ scale of measurement. Results: Noninvasively 305 (99.1%) eyes were detected positive for various type of DME by SD-OCT while 282 (91.6%) eyes were detected positive by FFA. The prevalence of different types of DME such as cystoids, diffuse, focal and mixed was 7.8%, 13%, 7.1% and 63.7% respectively as diagnosed with FFA. Whereas, SRF, IR edema and mixed type was 4.9%, 3.6% and 90.6% respectively as diagnosed with SD-OCT. DME was not detected by FFA in 8.4% of eyes in overall study population. Whereas, SD-OCT was unable to detect DME in 0.9% of eyes. In our study overall performance of SD-OCT was better in detection of DME when compared to FFA. Conclusion: The present study showed the diagnostic potential and efficacy of SD-OCT over FFA in reliable and safe detection of DME in Type II Diabetic Mellitus patients was more and was easy and

Морфометрические особенности диффузного макулярного отека при окклюзиях ретинальных вен

Морфометрические особенности диффузного макулярного отека при окклюзиях ретинальных вен

Results of Intravitreal Bevacizumab as an Adjunct to mETDRS Grid Laser in Diabetic Macular Edema

Purpose: To assess the efficacy of Intravitreal Bevacizumab as an adjuvant to grid laser photocoagulation in patients with diffuse macular edema (DME) in type II diabetes.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Institute of ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro, from September 2016 to November 2018&#x0D; Methods: Ninety five patients with diffuse macular edema in type II diabetes were selected by convenient sampling. Group I patients were treated with ETDRS grid laser photocoagulation. Group II patients were treated with ETDRS grid laser photocoagulation followed by intravitreal bevacizumab after one week monthly for 2 months and then as per need. All patients were examined after 1st, 2nd and 3rd month and mean change in best corrected visual acuity (BCVA) and central macular thickness (CMT).Statistical analysis was done on SPSS version 20.0. Paired t-test was used to compare mean values and p valve &lt; 0.05 was accepted as statistically significant.&#x0D; Results: The results of study were compared with the baseline values. The mean change in BCVA in group 1 was from 46 ± 18 letters to 52 ± 17. BCVA in group 2 was from 46 ± 18 letters to 56 ± 17 (P &lt; 0.001). The decrease in macular edema thickness was more in group II than group I (P &lt; 0.001).&#x0D; Conclusion: Macular Grid laser with or without Intravitreal Bevacizumab significantly improves vision and decreases macular edema but combined treatment led to more stable improvement in DME during follow-up.&#x0D; Key Words: Modified ETDRS laser, Bevacizumab, Macular edema, Anti-VEGF.

Macular structural changes and factors affecting final visual acuity in patients with Behçet uveitis.

To evaluate macular structural changes during the active and remission periods in patients with Behçet uveitis and to further assess the factors affecting final visual acuity. Clinical records and spectral domain-optical coherence tomography (SD-OCT) findings of patients with Behçet uveitis were retrospectively reviewed. Sixty-nine eyes of 35 patients were included in the study. SD-OCT findings in the active uveitis period included epiretinal membrane (ERM) in 26 (37.1%) eyes, ellipsoid zone (EZ) damage in 11 (15.7%), external limiting membrane (ELM) damage in 10 (14.3%), macular atrophy in 6 (8.6%), disruption of retinal pigment epithelium (RPE) in 11 (15.7%), a macular scar in 1 (1.4%), and loss of normal foveal contour appearance in 15 (21.4%). There was macular edema in 23 eyes (32.9%) in the active uveitis period (11 (15.7%) cystoid macular edema, 10 (14.3%) diffuse macular edema, and 7 (10.0%) serous retinal detachment). In the remission period, SD-OCT findings included ERM in 37 (52.9%) eyes, EZ damage in 14 (20%), ELM damage in 14 (20%), macular atrophy in 7 (10%), disruption of RPE in 14 (20.0%), macular scar in 1 (1.4%), and loss of normal foveal contour appearance in 17 (24.3%). The mean central macular thickness in the remission period was significantly lower than in the active uveitis period (p < 0.001). The presence of EZ damage and loss of normal foveal contour appearance in active uveitis period were the independent factors associated with final visual acuity (logMAR) (β = 0.736, p = 0.003; β = 0.682, p = 0.002, respectively). Ellipsoid zone damage and loss of normal foveal contour appearance are important factors affecting visual acuity in Behçet uveitis.

ASSESSMENT OF THE EFFECT OF PANRETINAL PHOTOCOAGULATION (PRP) ON MACULAR THICKNESS IN EYES WITH PROLIFERATIVE DIABETIC RETINOPATHY (PDR) WITHOUT CLINICALLY SIGNIFICANT MACULAR EDEMA

Background: Proliferative diabetic retinopathy (PDR) is the most advanced stage of DR. It significantly increases the risk for progressive vision loss, and without intervention, approximately one half of eyes ultimately experience severe vision loss. Although PRP is the gold standard treatment of PDR by reducing moderate visual loss by 50% in treatment groups, it also caused significant macular edema, which is recognized as the most common cause of decreased visual acuity in diabetic eyes. Optical Coherent Tomography (OCT) helps us studying these macular edema and its characteristics. Objective: To investigate the changes in macular thickness and morphology after panretinal photocoagulation (PRP) in eyes with proliferative diabetic retinopathy (PDR) and without clinically significant macular edema. Patients and Methods: This study enrolled 20 eyes of 15 patients with early proliferative diabetic retinopathy (PDR) without any clinically significant macular edema. Panretinal photocoagulation was applied 3 sessions, one week apart. Fundus fluorescein angiography and OCT were carried out for all patients before PRP. Baseline and post PRP visual acuity and central foveal thickness were evaluated after 3 months. Results: The mean patient age was 59.00±9.93 years (range, 33-72 years). Fifteen of the 20 eyes (75%) had stable or improved vision, while 5 eyes (25%) had worsened by 3 months following PRP. Mean preoperative vision was 0.50±0.1 decimal fraction, and although worsened at 3 months 0.48±0.15 decimal fraction, this was statistically insignificant (P = 0.453). Mean pre- PRP central foveal thickness was 253.05 ± 18.53 μm (ranging from 227 – 281μ), increased significantly to 281.45 ± 28.71 μm (ranging from 240 – 344μ) at 3 months’ follow-up (P˂ 0.001). Three months after PRP, 15 eyes developed complications. The most common abnormality was cystoid edema seen in 6 eyes (30%), followed by diffuse macular edema in 4 eyes (20%), posterior vitreous detachment (PVD) in 2 eyes (10%), neuro sensory detachment in two eyes (10%), and epiretinal membrane (ERM) in one eye (5%). Conclusion: Panretinal photocoagulation is safe, effective in treating and preserving vision in proliferative diabetic retinopathy (PDR), although causing temporary drop in vision and changes in macular morphology/thickness.

Association between the patterns of diabetic macular edema and photoreceptors' response after intravitreal ranibizumab treatment: a spectral-domain optical coherence tomography study.

To analyze photoreceptors' condition after intravitreal ranibizumab treatment according to the pattern of diabetic macular edema (DME) on spectral-domain optical coherence tomography (SD-OCT). Retrospective study includes 58 treatment naïve patients with DME, treated with intravitreal ranibizumab injections and followed up for at least 12months. Patients were classified based on DME morphology on SD-OCT into: diffuse macular edema, cystoid macular edema (CME) and serous retinal detachment with CME (SRD/CME). The DME morphology was analyzed, while quantitative measurement of ellipsoid zone (EZ) defect, as well as qualitative assessment of the condition of external limiting membrane (ELM) and interdigitation zone (IZ) at foveal area, was taken before and after treatment. Before treatment, patients with CME presented worse ELM and IZ condition and greater EZ defect than patients with diffuse macular edema or SRD/CME. After treatment, the restoration of EZ defect and IZ was more evident in patients with CME than in diffuse macular edema or SRD/CME. Patients with DME presented significant photoreceptors' restoration after intravitreal ranibizumab injections at the 12-month follow-up. The improvement in EZ defect size and IZ was dependent on the pattern of DME on SD-OCT.

Частота и структура диффузного макулярного отека при окклюзиях ретинальных вен

Частота и структура диффузного макулярного отека при окклюзиях ретинальных вен

Chronic Unilateral Uveitis as a Manifestation of Leprosy: A Case Report and Literature Review

ABSTRACT Purpose: To describe a case of leprosy presenting chronic anterior uveitis associated with other systemic lesions. Methods: Case report and systematic literature review. Results: We describe the case of a 65-year-old patient presenting clinical features of chronic uveitis and poor response to topical and intravitreal steroid treatment. Upon ocular examination, diffuse iris atrophy and macular edema were observed and laboratory tests for autoimmune and infectious diseases were within normal range. Physical examination revealed the presence of skin lesions on trunk and extremities, which were biopsied and identified as positive for leprosy. Conclusion: The case reported herein presented atypical characteristics of uveitis due to the involvement of the posterior segment of the eye. Leprosy diagnosis could be a challenge, a systematic approach is mandatory to achieve adequate treatment.

Spectral domain optical coherence tomography classification of diabetic macular edema: a new proposal to clinical practice.

To classify the types of diabetic macular edema (DME) and evaluate its morphological features on spectral domain optical coherence tomography (SD-OCT) and determine correlations between visual acuity and OCT findings. We assessed 406 eyes of 309 patients with a diagnosis of DME retrospectively. Three types based on SD-OCT were identified: diffuse macular edema, cystoid macular edema, and cystoid degeneration. Morphological features such as serous macular detachment (SMD), vitreomacular interface abnormalities (VMAI), hard exudates, photoreceptor status, and correlations between visual acuity and those morphological features were also evaluated by SD-OCT. The most common type of DME was cystoid edema (68.5%). No statistically significant difference was found between groups in sex (P = 0.40), type of diabetes (P = 0.50), or diabetic retinopathy (P=0.78). However, the duration of symptoms and BCVA was significantly lower in the group with cystoid degeneration compared with the group with cystoid edema (P < 0.001) and the group with diffuse macular edema (P < 0.001). In the group with cystoid degeneration compared with the groups with cystoid and diffuse edema, the central fovea and central subfield were significantly thicker (both (P < 0.001), the subfoveal choroid was significantly thinner (P = 0.049), rate of serous macular detachment was significantly lower (P < 0.001), and the rate of outer retinal damage was significantly higher (P < 0.001). Cystoid macular degeneration, which is consistent with poor functional and morphological outcomes, should be differentiated from cystoid macular edema. Serous macular detachment, which is mostly seen in eyes with early stages of DME, should be evaluated as an accompanying morphological finding rather than a type of DME.

Intravitreal Avastin as a Treatment of Diffuse Diabetic Macular Edema

Background: Macular edema, defined as retinal thickening within 2 disc diameters of the center of the macula, results from retinal microvascular changes that compromise the blood-retinal barrier, causing leakage of plasma constituents into the surrounding retina and, consequently, retinal edema. Focal edema is associated with hard exudate rings caused by leakage from micro aneurysms. Diffuse edema is caused by leakage from micro aneurysms, retinal capillaries, and arterioles. Avastin (Bevacizumab) is a recombinant humanized monoclonal IgG1 antibody that binds to and inhibits the biologic activity of human vascular endothelial growth factor (VEGF). It contains human framework regions and the complementaritydetermining regions of a murine antibody that binds to VEGF. Avastin produced in a Chinese Hamster Ovary mammalian cell expression system in a nutrient medium containing the antibiotic gentamicin and has a molecular weight of approximately 149 kilo Daltons. Purpose: To assess the anatomic effect and visual acuity response after intravitreal (Avastin) in patients with diffuse diabetic macular edema. Patients and Methods: This study included 15 eyes of15 Patients with stable diabetes mellitus with diffuse diabetic macular edema. All eyes had received some form of argon laser photocoagulation (pan retinal photocoagulation (PRP), Focal or Grid of duration not less than 6 months. Mean age of 59 years treated with two intravitreal injections of Avastin 1.25 mg in 0.05 ml six weeks apart. Patients were examined by experienced ophthalmologist visual acuity, evaluation of diabetic retinopathy, central macular thickness by optical coherence tomography each was evaluated at the begging of study (baseline) and follow-up visits. Results: 15 eyes of 15 diabetic patients with persistent diffuse macular edema with no improvement in visual acuity. All the patients received two injections of A vastin six weeks apart. No complications were observed in any patient. The mean baseline visual acuity was (log Mar=1.338±0.455) and the mean visual acuity at three months following the second intravitreal injection was (log Mar=1.094±0.254), the mean central macular thickness at baseline was 492 µm decreased to 369 µm at the end of three months. Conclusions: A vastin resulted in a significant decrease in macular thickness and improvement in visual acuity at three months after the second injection.