Improvement In Central Macular Thickness Research Articles

Anatomical, Functional, and Prognostic Results of Vitrectomy in Epiretinal Membranes Secondary to Retinal Vein Occlusions

Introduction: We investigated the anatomical and functional results of vitrectomy associated with the peeling of secondary epiretinal membranes (ERM) in patients with retinal vein occlusion (RVO) and determined the prognostic factors of surgical outcomes. Methods: This retrospective, multicenter, observational study included 50 patients with RVO who underwent vitrectomy with ERM removal between July 2012 and February 2021. Visual acuity (VA) and central macular thickness (CMT) were investigated up to 3 years. Univariate analysis identified the predictive factors associated with functional and anatomical outcomes. Results: Fifty eyes from 50 patients (62% with central RVO) were included. The mean VA of 0.9 ± 0.7 logMAR preoperatively improved to 0.5 ± 0.5 logMAR after 24 months (p = 0.01). Anatomically, the mean preoperative CMT was 501 ± 168 μm, decreasing to 348 ± 108 μm at month 24 (p = 0.008). By 36 months, VA had improved or stabilized in 90% of the eyes, whereas CMT had been reduced by at least 20% from baseline in 80% of the eyes. A lower number of intravitreal injections (IVI) were required after vitrectomy. Worse preoperative VA, absence of preoperative panretinal photocoagulation, and postoperative use of adjunctive IVI were associated with VA recovery. Higher baseline CMT and the use of preoperative dexamethasone injections were associated with an improvement in CMT. Conclusion: Vitrectomy for ERM secondary to RVO was effective in improving VA and recovering CMT for up to 3 years and reduced the number of IVIs.

Prognostic factors of visual outcome in central serous chorioretinopathy treated with subthreshold micropulse laser therapy.

Analyze the prognostic factors of visual outcome in central serous choriretinopathy (CSC) treated with subthreshold micropulse laser (SML) therapy through the most fundamental medical history and clinical examinations. It was a retrospective clinical study. We collected the most fundamental medical history and clinical examinations of CSC patients who received SML treatment, including visual acuity (VA) and spectral-domain optical coherence tomography (SD-OCT) of macular. Eyes were divided into two groups according the change of central macular thickness (CMT) before and one month after SML: CMT improvement and CMT deterioration group; divided into three groups according the change of VA: VA improvement, VA stability and VA decline group. Seventy-eight patients (eighty-three eyes) were enrolled. The baseline CMT was 339.83 ± 115.72μm, and the baseline VA was 0.43 ± 0.36. One month after SML, CMT was 281.13 ± 121.48μm, had a significant statistical improvement (p = 0.000); and VA was 0.46 + 0.42, had no significant statistical difference compared to baseline VA (p = 0.114). CMT of sixty-three eyes (75.90%) declined, and twenty eyes (24.10%) increased; VA of thirty-one eyes (37.35%) improved, fourteen eyes (16.87%) remained unchanged, and thirty-eight eyes (45.78%) declined. CMT and VA of twenty-seven eyes (32.53%) were both improved, and eleven eyes (13.25%) were both deteriorated. VA one month after SML was statistically correlated with age (p = 0.000), baseline VA (p = 0.000), and baseline CMT (P = 0.002). CMT and VA both improved one month after SML, and the improvement of CMT was more significant than VA. Elder age and poorer baseline vision indicated poorer VA one month after SML, while higher baseline CMT indicated better VA one month after SML.

Short-Term Comparison of Switching to Brolucizumab or Faricimab from Aflibercept in Neovascular AMD Patients.

Background and Objectives: In this study, our objective was to assess and compare the changes in visual and structural outcomes among patients with neovascular age-related macular degeneration (nAMD) who were switched from intravitreal aflibercept (IVA) to either intravitreal brolucizumab (IVBr) or intravitreal faricimab (IVF) injections in a clinical setting. Materials and Methods: This observational clinical study included 20 eyes of 20 patients switched to brolucizumab and 15 eyes of 14 patients switched to faricimab from aflibercept in eyes with nAMD. We measured the structural outcome (central macular thickness (CMT)) and the visual outcome (best-corrected visual acuity (BCVA); logMAR) as follows: just before the most recent IVA injection (B0), one month after the most recent IVA injection (B1), just before the first IVBr or IVF injection (A0), one month after (A1) and three months after (A3) the first IVBr or IVF injection. Results: BCVA showed significant improvement at A1 (0.25 ± 0.34) and at A3 (0.19 ± 0.24) compared to A0 (0.38 ± 0.35) in the IVBr group (p = 0.0156, p = 0.0166, respectively). CMT (μm) was significantly thinner at A1 (IVBr: 240.55 ± 51.82, IVF: 234.91 ± 47.29) and at A3 (IVBr: 243.21 ± 76.15, IVF: 250.50 ± 72.61) compared to at A0 (IVBr: 303.55 ± 79.18, IVF: 270.33 ± 77.62) in the IVBr group (A1: p = 0.0093, A3: p = 0.0026) and in the IVF group (A1: p = 0.0161, A3: p = 0.0093). There was no significant difference in BCVA and CMT improvement observed between two groups at any time point (p > 0.05 for all). Conclusions: Switching from aflibercept to either brolucizumab or faricimab has a significant anatomical effect in eyes with nAMD and both treatments appear to be effective short-term treatment options. There is a trend towards greater visual improvements and reductions in CMT with brolucizumab.

One-year Clinical Outcome of Topical Bromfenac in Central Serous Chorioretinopathy

Purpose: To evaluate the efficacy of topical bromfenac in treating central serous chorioretinopathy (CSC) over a 1-year period.Methods: A retrospective analysis was conducted on 57 patients (57 eyes) with CSC followed for > 1 year. Patients were divided into two groups: those treated with bromfenac eye drops twice daily (29 eyes) and a control group (28 eyes). Best-corrected visual acuity (BCVA), central macular thickness (CMT), and subretinal fluid (SRF) height were measured and compared between the two groups as was the proportion of chronic cases.Results: Significant improvements in CMT and SRF height were noted in both groups over the follow-up period. The bromfenac group demonstrated significantly lower CMT at 6, 9, and 12 months (p = 0.045, 0.042, and 0.023, respectively) and lower SRF height (p = 0.037, 0.048, and 0.046, respectively) compared to the control group. The proportion of chronic cases was significantly lower in the bromfenac group (17.2%) compared to the control group (42.9%, p = 0.035).Conclusions: Topical bromfenac reduced the rate of progression to chronic CSC and showed significant anatomical improvements after 6 months, suggesting its potential as an effective treatment option.

Intravitreal Injections of Bevacizumab (Avastin); which Dose is Recommended?

This study was conducted to evaluate the fast improvement, effectiveness & safety of intravitreal injections bevacizumab (Avastin), in different doses, for treating diabetic macular edema (DME). Eyes of 80 patients with diabetic macular edema were randomized and planned to receive three consecutive monthly intravitreal injections of 1.25 mg or 2.5 mg bevacizumab (forty patients for each group). Patients were observed for 4 weeks after 1st injection and the changes in the best-corrected visual acuity (BCVA), central macular thickness (CMT) and adverse events were compared between both groups. CMT was significantly reduced in both groups (P < 0.013). Significant improvements between baseline and 2weeks to 4weeks in the 2.5 mg group, were mean decrease in CMT was 318 t0 182(P<.001), mean BCVA is 0.16 improve to 0.7 and P value 0.001. Intraocular pressure (IOP)measurements post intravitreal (IV) bevacizumab injection was not raised its statistically significant (P < 0.001). CMT improvement with a dose of intravitreal IV injection 2.5 mg is promising a rapid safe effective response for treating DME without any ocular or systemic side effects but Follow-up is still short to make any specific treatment recommendations.

Efficacity and Safety of the Fluocinolone Acetonide Implant in Uveitic Macular Edema: A Real-Life Study from the French Uveitis Network.

To evaluate the safety and efficacy of the fluocinolone acetonide implant (FAi, Iluvien® Horus pharma, Nice, France) in non-infectious uveitic macular edema (UME) and to approach the predictive factors of treatment response. This retrospective, multicenter real-life study included patients with chronic non-infectious UME who received intravitreal FAi after at least two dexamethasone implants (DEXi). Twenty-six eyes from 22 patients (73.1% of females) were included. The mean age was 60.4 ± 16 years. The mean follow-up was 11.4 ± 2 months. The mean baseline best-corrected visual acuity (BCVA) was 0.43 ± 0.36 LogMAR, improving significantly after 1, 3, 6 and 12 months (all p < 0.05 vs. baseline). The mean baseline central macular thickness (CMT) was 429 ± 110 μm, improving significantly after 1, 3, 6 and 12 months (all p < 0.05 vs. baseline). Five eyes (19.2%) developed ocular hypertension during the follow-up, requiring initiation or strengthening of intraocular pressure lowering medication. The majority of eyes (77%) did not require any rescue DEXi during the available 12-month follow-up. The resolution of UME after DEXi seemed to predict the anatomical response after FAi. The baseline presence of a disorganization of the inner retinal layers (DRIL) and hyperreflective foci (HRF) were both associated with a higher likelihood of requiring rescue DEXi injections. FAi implantation led to a significant BCVA and CMT improvement with a good safety profile over the 12-month follow-up. Predictive factors of treatment outcomes seem to include the anatomical response to DEXi and the presence of DRIL and HRF at baseline.

Is Intravitreal Injection of Recombinant Tissue Plasminogen Activator Effective for the Treatment of Refractory Diabetic Macular Edema in Patients With Posterior Vitreous Detachment?

To determine whether intravitreal injection of recombinant tissue plasminogen activator (rTPA) is effective for the treatment of refractory diabetic macular edema (DME) in patients who already had posterior vitreous detachment (PVD). It is a retrospective chart review of the patients with refractory DME and PVD. The efficacy of intravitreal injection of rTPA was assessed based on the changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) in these patients. Nine eyes of nine patients as the study group and 14 eyes of the 14 patients as the control group were examined. Before the injections, the mean CMT was 470.0± 107.6 in the study group, compared to 536.2± 150.5 in the control group, with no statistical significance (p=0.403). The statistical analysis revealed no significant differences in the mean changes in CMT from baseline to one and three months after injections between the study and control groups (p=0.439, p=0.781, respectively). Likewise, no statistically significant disparities were observed in the mean pre-injection BCVA between the study group (0.877± 0.349) and the control group (0.950± 0.300) (p=0.415). Additionally, after three months of injection, there were no significant changes in the mean BCVA of the study group (0.844± 0.304) and the control group (0.864± 0.253) (p=0.512). This study showed that rTPA has no effect on changes in CMT and BCVA in patients who had refractory DME and PVD at the same time. This may suggest that the improvement in CMT in previous studies may be due to the induction of PVD.

Real-world experience of brolucizumab in nAMD.

To evaluate real-world outcomes with neovascular age-related macular degeneration (nAMD) in relation to anatomical success, visual outcomes, and safety of intravitreal brolucizumab (IVBr) injection at 1.5 years. Prospective, randomized, single-center study between December 2020 and December 2022 that included 71 eyes of 62 patients with nAMD, who received IVBr. Patients were divided into three groups, i.e., naïve choroidal neovascular membrane (CNVM), switched therapy (st) CNVM, and st polypoidal choroidal vasculopathy (stPCV). They were subdivided into dry, minimal fluid (fluid <50 microns)/pigment epithelial detachment (PED) and persistent fluid (fluid >100 microns)/PED subgroups depending upon the fluid level at the end of 1.5 years. Best-corrected visual acuity (BCVA), central macular thickness (CMT), status of fluid, and number of injections at 1.5 years were evaluated. From the beginning, patients were treated on pro re nata (PRN) basis. Of the 71 eyes, 27 eyes (38%) were naïve CNVM, 35 eyes (49.3%) were stCNVM, and 9 (12.7%) were stPCV cases. Significant vision improvement after 1.5 years was seen in the stCNVM category (P = 0.001), while CMT reduction was significant in all three groups (P < 0.05). The mean number of injections required in naïve CNVM and stCNVM groups was significantly less as compared to the stPCV group (P = 0.017). Further, vision improvement was significant in the "Minimal fluid" subgroup (P = 0.002), while the CMT improvement was significant in the "Minimal fluid" and "Dry" subgroups each with P < 0.0001. No ocular/systemic adverse events including intraocular inflammation (IOI) were noted. In a real-world scenario, with 203 procedures and 1.5-year follow-up, brolucizumab is found to be efficacious and safe with the need for a lesser number of injections and more interval-free period in the management of naïve CNVM, stCNVM, and stPCV patients.

Automated evaluation of retinal hyperreflective foci changes in diabetic macular edema patients before and after intravitreal injection.

Fast and automated reconstruction of retinal hyperreflective foci (HRF) is of great importance for many eye-related disease understanding. In this paper, we introduced a new automated framework, driven by recent advances in deep learning to automatically extract 12 three-dimensional parameters from the segmented hyperreflective foci in optical coherence tomography (OCT). Unlike traditional convolutional neural networks, which struggle with long-range feature correlations, we introduce a spatial and channel attention module within the bottleneck layer, integrated into the nnU-Net architecture. Spatial Attention Block aggregates features across spatial locations to capture related features, while Channel Attention Block heightens channel feature contrasts. The proposed model was trained and tested on 162 retinal OCT volumes of patients with diabetic macular edema (DME), yielding robust segmentation outcomes. We further investigate HRF's potential as a biomarker of DME. Results unveil notable discrepancies in the amount and volume of HRF subtypes. In the whole retinal layer (WR), the mean distance from HRF to the retinal pigmented epithelium was significantly reduced after treatment. In WR, the improvement in central macular thickness resulting from intravitreal injection treatment was positively correlated with the mean distance from HRF subtypes to the fovea. Our study demonstrates the applicability of OCT for automated quantification of retinal HRF in DME patients, offering an objective, quantitative approach for clinical and research applications.

Comparing functional and vascular layer outcomes of laser photocoagulation versus subthreshold micropulse laser for diabetic m.

To compare the efficacy of conventional laser (CL) and subthreshold micropulse laser (SML) for treating diabetic macular edema in terms of functional outcomes and changes in quantitative metrics for the retinal capillary and choriocapillary vascular layers. Fifty-two eyes from 52 patients with treatment-naïve clinically significant macular edema were randomly assigned to the CL or SML group in a 1:1 ratio. Best-corrected visual acuity, central macular thickness (CMT) and optical coherence tomography angiography (OCT-A) scans were measured at baseline, 1-, 3- and 6-months post-treatment. The SML group showed rapid visual recovery, improving from baseline of 0.320 ± 0.31 logMAR (20/42 Snellen) to 0.270 ± 0.22 logMAR (20/37 Snellen) at 1 month (p = 0.038); and had significant improvements in CMT at 6-month post-treatment (353.88 to 301.00µm, p = 0.005). Statistically significant changes were detected across all OCT-A metrics, including vessel density (VD), vessel length density (VLD), vessel diameter index (VDI) and fractal dimension (FD), at 6 months for both groups in the deep capillary plexus (DCP) and choriocapillary plexus (CCP). SML resulted in early visual recovery and sustained macular thickness improvement in the treatment of DME. Microvascular perfusion parameters, including VD, VLD and FD, improved in the DCP and CCP for both treatment groups at 6-months post-treatment.

Efficacy of intravitreal bevacizumab on diabetic macular oedema in an African population.

To evaluate the short-term effect of intravitreal bevacizumab (avastin) injection on visual outcomes of patients with diabetic macular oedema. A retrospective cross-sectional study was conducted to evaluate 39 eyes of thirty-nine patients (mean age ± SD: 61.4 ± 15.0years) that received intravitreal bevacizumab injection (1.25mg in 0.05ml) as treatment for diabetic macular oedema between January 2014 and July 2019 in Ghana. Data on visual acuity and central macular thickness before treatment and 6weeks post-treatment were collected and analysed using paired t-test. Ordinary least squares linear regression analysis was also conducted to determine the relationship between improvement in visual acuity and central macular thickness after treatment and other predictor variables. The mean ± SD visual acuity (LogMAR-equivalent of Snellen) of patients with diabetic macular oedema significantly improved from 0.84 ± 0.58 LogMAR before treatment to 0.69 ± 0.58 LogMAR at 6weeks post-treatment (mean difference: 0.15 ± 0.32 LogMAR; 95% CI: 0.04 to 0.25; p = 0.01). Mean macular thickness ± SD on the other hand, reduced significantly (p < 0.001) from 316.54 ± 75.35μm before treatment to 275.54 ± 57.43μm after treatment. While age and worse pre-treatment visual acuity predicted improvement in visual acuity after treatment, a higher central macular thickness before treatment predicted an improvement in central macular thickness after intravitreal bevacizumab injection. Treatment with intravitreal bevacizumab injection produces short-term improvement in vision and reduction in central macular thickness in African patients with diabetic macular oedema.

Topical interferon therapy in uveitic macular edema.

To evaluate efficacy of topical interferon alfa-2b (IFN) in the treatment of uveitic macular edema (UME). This is a prospective, interventional case study of patients with UME. Injection IFN was reconstituted into eye drops and a four times/day (QID) application was prescribed. Central macular thickness (CMT) on optical coherence tomography (OCT) scan was evaluated. Improvement in CMT by ≥50 μm from the baseline was studied in eyes with presenting CMT ≥400 μm. Twenty eyes of 20 patients with UME were studied: anterior uveitis (n = 3), anterior + intermediate uveitis (n = 5), posterior uveitis (n = 3), retinal vasculitis (n = 3), and panuveitis (n = 6). Mean CMT at the presentation was 423.3 μm (range: 270-604 μm), which improved at 1 month (n = 16), 2 months (n = 10), and ≥3 months (n = 11) follow-up, to 415.3 μm (range: 247-579 μm) (P = 0.411), 364.4 μm (range: 258-566 μm) (P = 0.099), 344 μm (range: 258-484 μm) (P = 0.001), respectively. Twelve eyes of 12 patients had presenting CMT ≥400 μm. In these cases, decrease in CMT by ≥50 μm was seen in 4/10, 4/5, and 5/6 eyes at 1 and 2 months and ≥3 months follow-up. Mean follow-up was 4 months (range: 1-17 months). Complete resolution of UME was seen only in three eyes. No ocular or systemic side effects were observed. Topical IFN therapy in QID doses is safe but may have limited role in UME. Long-term therapy may improve its efficacy. Larger studies with dose modification, combination with other drugs, and with homogeneous uveitis population are recommended.

Systemic glucocorticoid-free therapy with adalimumab plus immunosuppressants versus conventional therapy in treatment-naïve Vogt-Koyanagi-Harada disease patients.

BackgroundHigh dose systemic glucocorticoid is the main therapy of treatment-naïve Vogt-Koyanagi-Harada (VKH) disease. However, series side effects induced by high dose systemic glucocorticoid frequently occur, which makes alternative therapy necessary for certain patients. This study sought to compare the efficacy and safety of systemic glucocorticoid-free (SGF) therapy with conventional therapy (CT) as an initial treatment for VKH patients.MethodsVKH patients who had not been systemically treated were enrolled. Patients were allocated into 2 therapeutic groups depending on their treatments. In CT group, patients received systemic glucocorticoid plus immunosuppressants (IS), and in SGF group, patients received adalimumab (ADA) plus IS. Patients received approximately 12 months treatment and visit monthly. The outcome parameters included the changes of best-corrected visual acuity (BCVA), intraocular inflammation (including anterior chamber cell grade and vitritis grade) and central macular thickness (CMT) (the change values define as the final-visit values subtracted from baseline counterparts). Other outcomes included the relapses times of ocular inflammation, adverse events (AEs), changes of optic nerve inflammation (ONI) and intraocular/extraocular manifestations.ResultsA total of 30 patients (60 eyes) were included. with 19 patients (38 eyes) in CT group and 11 patients (22 eyes) in SGF group. After approximately 1 year of treatment, the improvements of BCVA were slight better in the SGF group (0.57±0.23) than in the CT group (0.40±0.26), (P=0.014). In both groups, the ocular inflammatory improvements in both groups were similar, with an improvement of AC cell grade of −1.5 (−2, −0.5) in CT group versus −1 (−2, −1) in SGF group (P=0.367); improvement of vitritis grade was 0 (−1.25, 0) in CT group and −1 (−1, −1) in SGF group (P=0.050). The improvement in CMT was similar in both groups, with −523.47±412.09 µm in CT group and −362.73±375.73 µm in SGF group (P=0.572). The mean number of relapses was 1 (0, 2) in the CT group and 0 (0, 2) in the SGF group (P=0.372). No severe AEs were observed in this study.ConclusionsSGF therapy is effective, safe, and well-tolerated in treatment-naïve VKH patients. SGF therapy seems to be a feasible option in patients with existing systemic diseases intolerant to glucocorticoid.

Possible role of Spironolactone in a sample of Iraqi patients with acute central serous chorioretinopathy

Background: Central serous chorioretinopathy (CSCR) is an idiopathic condition aggravated by exogenous or endogenous glucocorticoids. Vascular deregulation in the choroid is a new hypothesis regarding central serous chorioretinopathy occurrence. The inhibition of choroidal mineralocorticoid receptors has a great role in shortening the duration of CSCR by inhibiting choroidal vasodilatation and leak. Objective: To assess the effect of oral spironolactone on subretinal fluid, central macular thickness and visual acuity in patients with acute CSCR compared to observation. Subjects and Methods: a hospital based, randomized clinical trial carried out at outpatient clinic in Ibn-Alhaitham Teaching Eye Hospital/ Baghdad, enrolling 60 patients with acute unilateral CSCR, allocated randomly (every other patient) to either receiving spironolactone 25 mg orally, twice daily for 2 months (30 patients) or observation only (30 patients). The follow-up included visual acuity measurement, central macular thickness and subretinal fluid height examinations by ocular coherence tomography (OCT) at one- and two-months post enrollment for all patients. Results: Complete absorption of subretinal fluid was observed in 21(70%) of the eyes in the treatment group and in 6(20%) in the control group at two-months. Visual acuity and mean macular thickness improved significantly in both groups at the one- and two- months, mean changes was larger in treatment group compared to control group at the two-month-follow up endpoint. Conclusion: Oral spironolactone imparted greater improvement in central macular thickness and faster resolution of sub retinal fluid in patients with acute central serous chorioretinopathy versus observation.

Efficacy of intravitreal injection of aflibercept vs ranibizumab in the treatment of diabetic retinopathy

AIM: To systematically assess the effect of intravitreal injection of Aflibercept or Ranibizumab in the treatment of diabetic retinopathy (DR) by using Meta-analysis. METHODS: PubMed, MEDLINE, Web of Science, Cochrane, Nature Series, ScienceDirect, and ESI Databases were searched until May 2019. Ten studies included a total of 1240 participants with DR had been administered in the Meta-analysis. Aflibercept or ranibizumab via intravitreal injection. After selecting useful information, we used RevMan 5.3 to further analysis. Systematic review and meta-analysis were used to design. RESULTS: The pooled results showed that central macular thickness (CMT) was significantly reduced (P&lt;0.00001) in the intravitreous Aflibercept group (IVA); compared with the intravitreous Ranibizumab group (IVR), which did not greatly improve best corrected visual acuity (BCVA) and visual acuity (VA). CONCLUSION: This Meta-analysis suggests that both IVA and IVR are effective in the treatment of DR patients. Specifically, Aflibercept shows better improvements in CMT, while Ranibizumab is beneficial in increasing BCVA or VA.

Safety and Efficacy of Suprachoroidal Injection of Triamcinolone in Treating Macular Edema Secondary to Noninfectious Uveitis.

Introduction One of the leading causes of blindness throughout the world is uveitis, which predominantly results in the feared complication of macular edema. We report the safety and efficacy of suprachoroidal injection of triamcinolone acetonide in the treatment of macular edema secondary to noninfectious uveitis. Methodology This prospective, nonrandomized interventional study was conducted at Layton Rahmatullah Benevolent Trust (LRBT) Eye Hospital, Lahore, from August 2019 till July 2020. All individuals older than 18 years, nonpregnant females with a central macular thickness of >320 µm were included. Those patients with uncontrolled diabetes, immunodeficiency, or any other disease mandating systemic corticosteroid use were excluded. All patients had a detailed ocular exam one week before the treatment, and 0.1 ml of triamcinolone acetonide 40 mg/ml was injected using a 30-G hollow needle into the suprachoroidal space. After the injection, an eye patch was applied and the patient was observed for three hours. All data were documented in a preformed proforma. ResultsA total of 30 patients were included in the study with a mean age of 38.1 ± 9.48 years. Statistically significant differences were found between central macular thickness at presentation and at one and three months of the procedure, i.e., 569.60 ± 170.396, 266.77 ± 73.127, and 208.27 ± 37.292 µm, respectively. A similar difference was observed when comparing visual acuity at baseline to visual acuity at one and three months of the procedure (p < 0.001). Conclusion The current study indicates that a single dose of suprachoroidal injection of triamcinolone acetonide for the treatment of macular edema secondary to uveitis is safe and efficacious. No rise in intraocular pressure (IOP) was observed during the study period. Significant improvements in central macular thickness and visual acuity as well as tolerability and safety of the treatment were seen in our study. Further larger-scale studies are needed to ascertain the long-term benefits of the suprachoroidal triamcinolone acetonide.

Treatment Results of Bevacizumab for Macular Edema Secondary to Branch Retinal Vein Occlusion

Purpose: To evaluate the results of treatment according to the method of intravitreal injection of bevacizumab for macular edema due to branch retinal vein occlusion (BRVO). Methods: The clinical records of macular edema patients were analyzed retrospectively for a total of 62 eyes of 62 patients who were injected with bevacizumab into the vitreous as the first treatment for BRVO. Best-corrected visual acuity (BCVA), the findings of spectral-domain optical coherence tomography before and after injection, and prognosis-related factors were evaluated for 21 eyes that received the initial three monthly loading treatments and the 41 eyes that did not. Results: Significant improvement in BCVA was observed in the group having received the initial three injections compared with the group who did not receive the injections at 3, 6, and 12 months (&lt;i&gt;p&lt;/i&gt; = 0.025, &lt;i&gt;p&lt;/i&gt; = 0.019, and &lt;i&gt;p&lt;/i&gt; = 0.008, respectively). The central macular thickness (CMT) showed greater improvement in the initial three injections group than the group without at 6 months (&lt;i&gt;p&lt;/i&gt; = 0.034). Multivariate regression showed that the duration from the onset, the three loadings, BCVA, disorganization of the retinal inner layer (DRIL), and choroidal thickness were predictors related to visual gain (&lt;i&gt;p&lt;/i&gt; = 0.044, &lt;i&gt;p&lt;/i&gt; = 0.047, &lt;i&gt;p&lt;/i&gt; = 0.004, &lt;i&gt;p&lt;/i&gt; = 0.045, and &lt;i&gt;p&lt;/i&gt; = 0.034, respectively). Age, three loadings, BCVA, and DRIL were predictors related to final visual acuity (&lt;i&gt;p&lt;/i&gt; = 0.045, &lt;i&gt;p&lt;/i&gt; = 0.046, &lt;i&gt;p&lt;/i&gt; = 0.002, and &lt;i&gt;p&lt;/i&gt; = 0.034, respectively). Duration from the onset, CMT, and choroidal thickness were predictors related to CMT improvement (&lt;i&gt;p&lt;/i&gt; = 0.042, &lt;i&gt;p&lt;/i&gt; = 0.009, and &lt;i&gt;p&lt;/i&gt; = 0.015, respectively). Conclusions: In macular edema of BRVO, the initial three monthly intravitreal injections of bevacizumab provided superior treatment outcomes regarding short-term functional and anatomical improvements and long-term functional improvement, compared with methods that did not treat with the initial three monthly injections.

Comparison of two-year treatment outcomes between subthreshold micropulse (577nm) laser and aflibercept for diabetic macular edema.

To compare two-year treatment outcomes of subthreshold micropulse (577nm) laser and aflibercept for diabetic macular edema (DME). Retrospective case-control study. A total 164 eyes in 164 DME patients treated with either micropulse laser (86 eyes) or intravitreal aflibercept monotherapy (78 eyes) were recruited. Main outcome measures included at least five Early Treatment Diabetic Retinopathy Study (ETDRS) letters' improvement from baseline at 6, 12 and 24months. Rescue aflibercept was initiated in 24% of eyes in micropulse laser group. At 6-month visit the aflibercept group achieved a higher percentage of eyes with at least 5-letter visual acuity improvement than micropulse laser group (56% vs 38%, P = 0.044), however, this was not the case at 12-month (45% vs 49%, P = 0.584) and 24-month visits (49% vs 57%, P = 0.227). At 6-month visit the aflibercept group achieved a higher percentage of eyes with at least 10% improvement of central macular thickness (73% vs 49%, P = 0.005), but this was not the case at 12-month (73% vs 70%, P = 0.995) and 24-month visits (85% vs 84%, P = 0.872). Aflibercept achieved faster and higher rates of anatomical and functional improvement than micropulse laser in DME patients. Long term efficacy of treatment did not result in significant differences between aflibercept monotherapy and micropulse laser in DME patients. Primary treatment of micropulse laser with deferred rescue aflibercept might be the treatment option without reducing the chance of visual improvement in DME eyes.

Comprehensive evaluation of intravitreal conbercept versus half-dose photodynamic therapy for chronic central serous chorioretinopathy.

To compare the safety and efficacy of conbercept intravitreal injection and half-dose photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC). This study was retrospective. Thirty-seven patients (37 eyes) with chronic CSC received conbercept injections while 57 patients (57 eyes) were treated with half-dose PDT. All subjects were followed in 6mo. Outcome measures included change in best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and resolution of subretinal fluid (SRF). There was no adverse event observed in either treatment group. At the 6-month follow-up, 26 eyes (70.3%) in the conbercept group and 54 eyes (94.7%) in the half-dose PDT group (P<0.05) reached full resolution of SRF. The mean logarithm of the minimum angle of resolution (logMAR) BCVA significantly improved (P<0.001) in both treatment groups with better outcome at early phase in the half-dose PDT group (2wk, 1, and 2mo, P<0.05). All subjects experienced significant CMT improvement (P<0.001) with no statistical difference between the two groups (P>0.05). The SFCT also improved in all subjects (P<0.001) with better outcome in the half-dose PDT group (P<0.05). Both intravitreal conbercept and half-dose PDT are safe to use in treating chronic CSC. By 6mo, both treatment groups are efficacious in improving BCVA, reducing CMT and SFCT, and resolving SRF in eyes with chronic CSC. Half-dose PDT may show better outcome at initial phase of treatment in chronic CSC. Longer follow-up period is necessary to study for long-term effect and safety.

Intravitreal Dexamethasone Implant for Postoperative Macular Oedema Secondary to Vitrectomy for Epiretinal Membrane and Retinal Detachment: A Systematic Review and Meta-Analysis.

Purpose To evaluate the efficacy of intravitreal dexamethasone implant (DEX) for the treatment of macular oedema secondary to vitrectomy for epiretinal membrane (ERM) and retinal detachment (RD) by conducting a systematic review with meta-analysis of published studies. Methods Studies reporting clinical outcomes of DEX use for the treatment of macular oedema secondary to ERM and RD vitrectomy were searched on PubMed and Embase databases. The primary outcome was best-corrected visual acuity (BCVA) change between baseline and post-DEX treatment, reported as mean difference (MD) with 95% confidence interval (CI). Mean central macular thickness (CMT) change was assessed as a secondary outcome. Postimplant adverse events, including intraocular pressure rise and cataract development, were reported as well. Results Five uncontrolled studies, 1 nonrandomized controlled study, and 1 randomized controlled study were included, with a total of 5 cohorts and 3 cohorts in the ERM group and RD group, respectively. Considering the last available follow-up, a significant improvement in postimplant BCVA was found in the overall population, irrespective of the indication for vitrectomy (MD = −0.28, 95% CI = −0.37, −0.20; p < 0.001), but with significant heterogeneity. In either group, mean BCVA significantly improved following the implant (in the ERM group, MD = −0.31, 95% CI = −0.40, −0.22; in the RD group, MD = −0.22, 95% CI = −0.41, −0.03), with no difference between the two groups (p=0.41). However, there was significant heterogeneity in both groups. Considering the last available follow-up, a significant CMT reduction was found in the overall population, irrespective of the indication for vitrectomy (MD = −129.75, 95% CI = −157.49, −102.01; p < 0.001). In the ERM group, a significant CMT reduction was shown following DEX (MD = −133.41, 95% CI = −155.37, −111.45; p < 0.001), with no heterogeneity. In the RD group, mean CMT reduction was borderline significant (MD = −128.37, 95% CI = −253.57, −3.18; p=0.040), with significant heterogeneity. No difference in CMT improvement was found between the two groups (p=0.94). Conclusion This meta-analysis showed that DEX yielded a significant improvement in visual and anatomical outcomes, even if limited by significant heterogeneity. Dexamethasone implant represents an effective treatment for postoperative macular oedema secondary to ERM and RD vitrectomy.