Mean Baseline Central Macular Thickness Research Articles

One-Year Functional and Morphological Prognosis After Intravitreal Injection Treatments According to Different Morphological Patterns of Diabetic Macular Edema in Real-Life: MARMASIA Study Group Report No.13

ABSTRACT Purpose To evaluate the responses of different optical coherence tomography (OCT) patterns of diabetic macular edema (DME) to intravitreal injection therapy. Methods In this retrospective, comparative, and multicenter study, patients who had previously untreated DME, who received intravitreal ranibizumab (IVR) or aflibercept (IVA) and/or steroid treatment with the pro re nata (PRN) treatment regimen after a 3-month loading dose, and had a 12-month follow-up in the MARMASIA Study Group were included. Morphological patterns of DME were divided into four groups based on OCT features diffuse/spongious edema (Group 1), cystoid edema (Group 2), diffuse/spongious edema+subretinal fluid (SRF) (Group 3), and cystoid edema+SRF (Group 4). Changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) at months 3, 6, and 12, and the number of injections at month 12 were compared between the DME groups. Results 455 eyes of 299 patients were included in the study. The mean baseline BCVAs [Logarithm of the Minimum Angle of Resolution (logMAR)] in groups 1, 2, 3, and 4 were 0.54 ± 0.24, 0.52 ± 0.25, 0.55 ± 0.23, and 0.57 ± 0.27, respectively. There was no significant difference between the baseline mean BCVAs between the groups (p = .35). The mean BCVAs were significantly improved to 0,47 ± 0,33 in group 1, 0,42 ± 0,33 in group 2, 0,47 ± 0,31 in group 3, and 0,45 ± 0,43 at month 12. There was no significant difference between the groups in terms of BCVA change at month 12 (p = .71). The mean baseline CMTs in groups 1, 2, 3, and 4 were 387,19 ± 128,19, 447,02 ± 132,39, 449,12 ± 109,24, and 544,19 ± 178,61, respectively. At baseline, the mean CMT was significantly higher in Group 4 than in the other groups (p = .000). The mean CMTs were significantly decreased to 325,16 ± 97,55, 334,94 ± 115,99, 324,33 ± 79,20, and 332,08 ± 150,40 in four groups at month 12 respectively (p > .05). The groups had no significant difference in mean CMT at month 12 (p = .835). The change in CMT was significantly higher in Group 4 than in the other groups at month 12 (p = .000). The mean number of intravitreal anti-VEGF injections at month 12 was 4.51 ± 1.57 in Group 1, 4.63 ± 1.54 in Group 2, 4.88 ± 1.38 in Group 3, and 5.07 ± 1.49 in Group 4. The mean number of anti-VEGF injections in Group 1 and Group 2 was significantly lower than in Group 4 (p = 0,014 and p = 0,017). Conclusions In real life, there was no significant difference between the DME groups in terms of visual improvement at month 12. However, better anatomical improvement was achieved in Group 4 than in the other DME groups.

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.

New individualized aflibercept treatment protocol for branch retinal vein occlusion with macular edema

We evaluated the long-term (24-month) efficacy of a novel individualized treatment protocol with 2 mg aflibercept for treatment-naive BRVO with macular edema. Each patient received an initial aflibercept injection and was then examined every 2 weeks until recurrence of edema. At recurrence, each patient received a second injection of aflibercept. The period of efficacy was defined as the time between the first and second injections. Subsequently, each patient was examined and re-injected with aflibercept at their personalized treatment interval, which was defined as 1 week shorter than the period of efficacy. Thirty-seven eyes of 48 patients showed recurrence after the initial injection. The mean period of efficacy was 92.5 ± 40.8 days, and the mean number of visits before recurrence, 7.6 ± 2.9. The mean 24-month best corrected visual acuity (BCVA) was significantly better than the mean baseline BCVA but significantly worse than the best BCVA during the period of efficacy. The mean gain of BCVA at 24 months was 0.07 ± 0.18 logMAR. The mean 24-month central macular thickness (CMT) was significantly lower than the mean baseline CMT but showed no difference from the mean best CMT (p = 0.060). The mean total number of visits during the 24 months was 15.8 ± 3.4. We conclude that the individualized treatment protocol that was based on the period of efficacy in treatment-naïve BRVO eyes with macular edema achieved satisfactory long-term visual outcome.

Haller Layer Thickness after Intravitreal Aflibercept Injection in Diabetic Macular Edema: 1 Month Change

Purpose: To analyze the changes in subfoveal Haller layer thickness (SFHT), subfoveal choroidal thickness (SFCT), and central macular thickness (CMT) after intravitreal aflibercept injection.Methods: This was a retrospective analysis of 36 diabetic macular edema patients who underwent intravitreal aflibercept injection between December 2016 and June 2021. The SFHT, SFCT, and CMT before and 1 month after the injection were compared using spectral-domain optical coherence tomography.Results: Mean baseline SFHT, SFCT, and CMT were 214.28 ± 80.00 μm, 307.89 ± 96.30 μm, and 525.64 ± 133.24 μm, which were reduced 1 month after the injection to 199.56 ± 75.76 μm, 290.36 ± 94.63 μm, and 409.72 ± 98.45 μm, respectively (&lt;i&gt;p&lt;/i&gt; = 0.001, &lt; 0.001, and &lt; 0.001, respectively). There was a significant correlation between baseline SFHT and 1-month post-injection best-corrected visual acuity (BCVA), while thicker subfoveal Haller layers before the injection were associated with better BCVA after the injection (ρ = −0.342; &lt;i&gt;p&lt;/i&gt; = 0.041).Conclusions: In diabetic macular edema patients, SFHT, SFCT, and CMT decreased significantly over 1 month after the first intravitreal aflibercept injection. Greater SFHT before the injection was a good short-term predictor of BCVA after injection.

Comparison of Ranibizumab Treatment Response of Superior and Inferior Temporal Branch Retinal Vein Occlusion: A Year Follow-Up.

Objectives:The aim of the study was to compare ranibizumab treatment response of macular edema secondary to superior and inferior temporal branch retinal vein occlusion.Methods:Sixty-four eyes of 64 patients treated with 0.5 mg/0.05 mL ranibizumab due to macular edema secondary to branch retinal vein occlusion were enrolled in this retrospective study. Thirty-eight eyes with superior temporal branch retinal vein occlusion were classified as Group 1 and 26 eyes with inferior temporal branch retinal vein occlusion as Group 2. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and the number of intravitreal injections were evaluated and compared between the groups.Results:The mean baseline, 3rd, 6th, 9th, and 12th month BCVA values in Group 1 were 0.77±0.47, 0.37±0.20, 0.37±0.22, 0.38±0.24, and 0.35±0.18 logarithm of the minimum angle of resolution (logMAR) and in Group 2 were 0.75±0.45, 0.37±0.18, 0.35±0.19, 0.32±0.17, and 0.28±0.20 logMAR, respectively. The mean baseline, 3rd, 6th, 9th, and 12th month CMT values in Group 1 were 522.92±136.01, 318.03±66.65, 287.53±48.27, 271.95±32.47, and 280.47±91.66 µm and in Group 2 were 524.08±145.51, 289.85±53.08, 268.96±31.57, 260.77±30.22, and 244.04±44.78 µm, respectively. BCVA and CMT improved significantly within both groups after the treatment (p<0.05) and there was no statistically significant difference between the groups (p>0.05). However, a significantly higher number of injections was needed for Group 1.Conclusion:Ranibizumab improved the visual and anatomical outcomes similarly in both superior and inferior temporal branch retinal vein occlusion with macular edema. However, more frequent injections were needed to achieve the same efficacy in superior temporal branch retinal vein occlusion.

Four-year outcomes of intravitreal aflibercept treatment for neovascular age-related macular degeneration using a treat-and-extend regimen in Japanese patients.

Objective:The purpose of our study was to determine the 4-year visual and anatomic outcomes of intravitreal aflibercept treatment for neovascular age-related macular degeneration (AMD) using a treat-and-extend (TAE) regimen.Methods:We retrospectively reviewed the medical records of 39 patients with neovascular AMD who were treated continuously with intravitreal aflibercept injections using the TAE regimen for at least 4 years. The outcome measures were the best-corrected visual acuity (BCVA) and central macular thickness (CMT) on spectral-domain optical coherence tomography. The BCVAs were measured as decimal values and converted to the corresponding Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores for statistical analysis. The Wilcoxon signed-rank test was used to compare the differences in BCVAs and CMTs.Results:The mean ETDRS letter scores improved significantly from 63.9 at baseline to 70.4, 67.8, 67.2, and 67.3 at 1, 2, 3, and 4 years, respectively. The mean baseline CMT was 380 µm, which decreased significantly to 229, 231, 221, and 210 µm at 1, 2, 3, and 4 years, respectively. The mean numbers of injections were 7.9, 6.0, 5.5, and 5.4 at 1, 2, 3, and 4 years, respectively. The percentages of patients with a treatment interval of 12 weeks or more were 46.2%, 46.2%, 43.6%, and 46.2% at 1, 2, 3, and 4 years, respectively. At year 4, 30.8% of the patients had a treatment interval of 7 weeks or less, whereas 25.6% had 16 weeks or more.Conclusion:Intravitreal aflibercept TAE treatment may be an effective and efficient method for treating patients with neovascular AMD up to 4 years of follow-up. The TAE regimen is a potential tool to optimize appropriate treatment intervals, avoiding both undertreatment and overtreatment of neovascular AMD.

Effect of Intravitreal Bevacizumab Injection before Panretinal Photocoagulation on the Prevention of Macular Edema Aggravation in Proliferative Diabetic Retinopathy.

Objective: To investigate the effects of intravitreal bevacizumab (IVB) injection before PRP on the prevention of macular edema (ME) in patients with PDR. Methods: This retrospective observational study included patients diagnosed with PDR treated by PRP with (combination group) or without (PRP alone group) preoperative IVB injection (1.25 mg/0.05 mL). The primary outcome measure was the change in the central macular thickness (CMT), while the secondary outcome measure was the change in visual acuity. Measurements were made before and at one, two, and three months after treatment. Results: In the PRP alone group, the mean baseline CMT of 277.8 μm increased to 290.4 μm at one month (p = 0.201) and 308.8 μm at two months (p = 0.002), followed by a decrease to 271.2 μm at three months (p = 0.437). In the combination group, the values at baseline and one, two, and three months after PRP were 322.9 μm, 295.4 μm (p = 0.002), 330.1 μm (p = 0.906), and 274.5 μm (p = 0.030), respectively. Visual acuity changes were comparable between the two groups at all time points. Conclusion: IVB injection before PRP leads to decreased CMT in comparison to CMT in patients with PRP alone.

Outcomes of Intravitreal Bevacizumab in Patients with Diabetic Macular Edema at a Tertiary Hospital in Northern Tanzania

Background: Diabetic macular edema is a type of diabetic maculopathy affecting the central vision, ranging from mild blur to blindness. Laser photocoagulation has been the mainstay of treatment for the past three decades but it has a limited role in improving the central vision. Recent introduction of anti-vascular endothelial growth factors appears to be promising in restoring vision. However, due to its short half life multiple injections are required to control edema and maintain vision. Objectives: To determine the visual and anatomical outcomes of intravitreal bevacizumab in patients with diabetic macular edema.&#x0D; Methods: A hospital based retrospective cross-sectional study was done at Kilimanjaro Christian Medical Center eye department from 2011- 2015. During this time, patients with diabetic macular edema who were given intravitreal bevacizumab and satisfied the inclusion criteria were included in the study. Visual acuity, central macular thickness and macular volume were recorded at baseline, six, twelve, eighteen, twenty four and thirty weeks respectively. Optical coherence tomography was used to record central macular thickness and macular volume. Univariate and multivariate binary regression analysis were done and the p-value, odds ratio and 95% confidence interval were calculated.&#x0D; Results: The prevalence of Diabetic macular edema was 15.4%. Mean baseline visual acuity improved from 0.9 ± 0.57 log MAR (6/48) to 0.6±0.49 log MAR (6/24) (95% CI 0.207 - 0.389) at 30 weeks. The mean baseline central macular thickness decreased from 426.97 ± 148.358 μm to 280.98 ± 95.89 μm at 30 weeks (95% 151.531 - 187.044, P &lt; .001). The mean baseline macular volume decreased significantly from 10.59 ± 2.55 mm3 to 8.38 ± 1.498 mm3 (95% CI 1.860 - 2.886) at 30 weeks. In multivariate analysis, patients with no hypertension were more likely to have a better visual outcome of 6/18 or better (95% CI 1.064 - 4.420, P &lt; .033).&#x0D; Conclusion: This study shows a high burden of diabetic macular edema in our setting. Intravitreal bevacizumab injection results in better visual and anatomical outcomes.

Comparison of Safety and Efficacy of Intravitreal Ziv-Aflibercept Vs Bevacizumab for the Treatment of Macular Edema

Purpose: To study the safety and efficacy of intravitreal Ziv-Aflibercept vs. Bevacizumab for the management of edema caused by different retinal pathologies.&#x0D; Study Design: Comparative interventional study.&#x0D; Place and Duration of Study: Lahore General Hospital, Lahore, from July 2018 to June 2019.&#x0D; Material and Methods: Patients with resistant, center involving macular edema due to diabetes, retinal vein occlusion and age related macular degeneration were recruited. Complete ocular examination was performed. All the patients were randomly grouped into two i.e. IVZ (intravitreal Ziv-Aflibercept) and IVB (intravitreal bevacizumab). Each eye underwent intravitreal injection of 0.05 ml of fresh filtered ziv-aflibercept (1.25 mg) or 0.05 ml of fresh filtered Bevacizumab. Outcome was measured in terms of variation in central macular thickness (CMT) and also best corrected visual acuity (BCVA) at 3 months.&#x0D; Results: Total of 156 eyes of 136 patients completed whole duration of study and were included in the results. The mean baseline CMT was 510 μm (± 94 μm) in the IVB group and 493μm (±102 μm) in the IVZ group (P = 0.94). The mean baseline BCVA (log MAR) was 0.78 (Snellen's equivalent 6/36) in the IVZ and 0.70 (Snellen's equivalent 6/30) in the IVB group (P = 0.78). Central macular thickness was significantly reduced at 1st, 2nd and 3rd month in the IVZ group and IVB group (P &lt; 0.001).&#x0D; Conclusion: Intravitreal Ziv-Aflibercept is safe and more effective than Bevacizumab for the treatment of edema caused by diabetes mellitus, retinal vein occlusion and wet age related macular degeneration.

Factors Predicting Treatment Response in Anti-Vascular Endothelial Growth Factor Naïve Diabetic Macular Edema Patients Treated with Intravitreal Bevacizumab.

Purpose: To identify factors that affect the therapeutic response of intravitreal bevacizumab in diabetic macular edema (DMO) and explore the correlation between the functional and anatomical outcomes observed. Methods: A retrospective, noncomparative, consecutive case series design was used. Baseline imaging data and clinical records of 65 eyes with DMO, secondary to type II diabetes mellitus, which received intravitreal bevacizumab for the first time in 2016, were analyzed. The central macular thickness (CMT), macular volume, and best-corrected visual acuity (BCVA), following the initial 3 injection loading phase were recorded. Outcomes were compared to multiple variables including glycemic control, diabetic retinopathy grade, DMO subtype on optical coherence tomography, and use of past macular laser therapy. Results: The participants' age ranged from 46 to 84 of which 63% were men and 37% were women. The mean baseline CMT was 443.21 μm. A mean reduction of 11.23% (P < 0.0005) in CMT was observed following the loading phase. Women exhibited a greater reduction in CMT (P = 0.032). Participants with diffuse retinal thickening (DRT) and with cystoid macular edema (CMO) showed a net reduction in CMT of 17.39% (P = 0.047) and 8.24% (P = 0.04) respectively. Eyes with proliferative diabetic retinopathy demonstrated a mean gain in CMT of 16.86% (P = 0.001). Conclusions: Female patients and DRT demonstrated a positive anatomical response. Patients with CMO and proliferative diabetic retinopathy displayed a negative therapeutic response. Such observations may be considered in clinical decision-making when opting for anti-vascular endothelial growth factor (VEGF) therapy for DMO.

Effect of Intravitreal Bevacizumab in Macular Edema Caused by Branch Retinal Vein Occlusion

Purpose: To evaluate the effect of intra-vitreal bevacizumab in macular edema caused by branch retinal vein occlusion.&#x0D; Study Design: Interrupted time series study.&#x0D; Place and Duration of Study: Department of Ophthalmology Hayatabad Medical Complex, Peshawar and department of Ophthalmology Lady Reading Hospital Peshawar from 1st July 2016 to 31st December 2016.&#x0D; Material and Methods: There were 60 patients included in the study. All patients with macular edema due to BRVO visible clinically and evident on SD-OCT and visual acuity of less than 6/9 were included in the study. Patients who used other intra-vitreal drug for macular edema, those with surgery in the same eye and those with macular laser for macular edema were excluded from the study. All patients were given intra-vitreal 0.05 ml bevacizumab injection every month for 6 months. After 6 months OCT was repeated. At each monthly visit VA was measured and fundoscopy was done. Follow up of all patients was at six months.&#x0D; Results: Our study included 60 patients with mean age of 54.42 ± 9.19 years. The mean baseline central macular thickness was 427.06 µ with SD ± 63.54 µ. After 6 months significant improvement in visual acuity was documented. Also marked reduction in central macular thickness was noted after six months with mean of 327.44 µ with SD ± 55.55 µ.&#x0D; Conclusion: Intra-vitreal bevacizumab is an effective treatment for macular edema caused by BRVO in terms of both anatomic and visual improvement.&#x0D; Key words: Branch retinal vein occlusion, bevacizumab, macular edema.

Focal laser application versus bevacizumab for treatment of central serous chorioretinopathy

Aim To report and compare the efficacy of macular grid laser versus intravitreal bevacizumab injection (IVBI) in patients with central serous chorioretinopathy (CSCR). Patients and methods A prospective study on 36 eyes of 35 patients with CSCR was conducted. The diagnosis of CSCR was established by fluorescein angiography and optical coherence tomography (OCT). All patients underwent measurement of best-corrected visual acuity, intraocular pressure, dilated fundus examination, and (OCT) imaging at baseline and follow-up visits. Fluorescein angiography was performed at baseline visit and thereafter depending on clinical and OCT findings. Patients were classified into group A, comprising 19 patients who were treated with macular grid laser and group B, comprising 17 patients who were treated with IVBI. The outcome measures were the resolution of neurosensory detachment, improvement in visual acuity, and resolution of leakage. All cases were evaluated after 3, 6, 12, and 24 weeks. Data were classified into two groups and statistically analyzed. Results In group A, the mean age of patients was 43.6 years (range, 23–52 years), there were 11 (57.89%) males and eight (42.10%) females, and the mean of follow-up period was 9.2 months (range, 7–18 months). The mean log MAR visual acuity score improved from 0.8 to 0.40 after 3 months of follow-up. The mean baseline central macular thickness (CMT) was 466 µm (range, 358–576 µm), which decreased to 309 µm (range, 268–356 µm) after 6 weeks, with statistically significance difference change from the baseline, and to 247 µm (range, 225–319 µm) after 3 months, with statistically significance difference change from the baseline (P Conclusion Both macular grid laser and IVBI for CSCR can lead to improvements of visual acuity and hasten recovery period. Macular grid laser may be considered as effective as anti-vascular endothelial growth factor for treatment of CSCR. More studies using larger scales may be needed to clarify the uncertain relationship between pathogenesis and results of treatment.

Going green - treatment outcome and safety profile of chronic central serous chorioretinopathy treated with subthreshold green laser.

AimSubthreshold lasers have gained popularity in the treatment of chorioretinopathy central serous chorioretinopathy (CSCR) and yellow (577 nm) lasers have completely revolutionized the treatment. However, there is very little literature regarding the use of a more common and conventional – green (532 nm) subthreshold laser for the treatment of chronic CSCR. We report the use of green (532 nm) laser for the treatment of chronic CSCR and its outcome.MethodsEyes with nonresolving CSCR were treated with green subthreshold laser and evaluated at the end of 5 months. Visual acuity, central macular thickness (CMT), and macular volume (MV) at baseline and at 5 months following treatment were evaluated.ResultsThirteen eyes with chronic CSCR were treated with green laser in SP-Mode™. The mean duration of CSCR was 7.64±3.77 months at the time of treatment. The median age of the patients was 41 (35–57) years. The baseline mean best-corrected visual acuity (BCVA) was 0.96 logMAR ± 0.17, with mean baseline CMT of 503.8 μm ± 181.9 and MV of 12.8 mm3 ± 3.81. The mean CMT at 5 months was 211 μm ± 31.7 and mean MV was 9.65 mm3 ± 0.60, correlating to a mean decrease of 292 μm ± 79 in CMT and mean decrease of 3.18 mm3 ± 1.87 in the MV from baseline (P<0.05). The mean BCVA after treatment was 0.18 logMAR±0.09 (P<0.05). Two cases of CSCR with pigment epithelial detachment (PED) also had complete resolution of both at 5 months.ConclusionSubthreshold green laser (532 nm) is a safe and effective modality for the treatment of chronic CSCR with very good and stable outcomes. It may also be beneficial in the treatment of PEDs.

Intravitreal aflibercept versus intravitreal ranibizumab for the treatment of diabetic macular edema.

PurposeThe purpose of this study was to compare the efficacy of intravitreal aflibercept and ranibizumab in the treatment of diabetic macular edema (DME) in eyes with moderate visual loss.Patients and methodsThis study is a randomized prospective study. Seventy eyes with DME were divided into two groups (each containing 35 eyes). Eyes in group I were treated with intravitreal injection of 2 mg/0.05 mL aflibercept and eyes in group II were treated with intravitreal injection of 0.5 mg/0.1 mL ranibizumab. All the eyes had three successive injections as a loading dose (with 1 month interval), and then the patients were followed up monthly for 12 months. The outcomes of the study were visual acuity, central macular thickness (CMT), and the number of re-injections of the drug.ResultsMean age of the patients in group I was 55.05±4.7 years and in group II was 56.64±5.8 years (P=0.17). The mean baseline best corrected visual acuity (BCVA) of eyes treated with aflibercept was 0.17±0.05 and with ranibizumab was 0.18±0.04 (P=0.9). BCVA was improved in both the groups at the end of the follow-up period and was found to be 0.42±0.28 and 0.37±0.23, respectively (P=0.27). The mean baseline CMT of eyes in group I was 465.29±33.7 µm and in group II was 471.5±34.4 µm (P=0.65). CMT decreased in both the groups to 360.8±85.7 µm and 387.3±87.8 µm, respectively (P=0.2). The mean number of drug re-injection was 2.62±0.68 and 3.03±0.95 in both the groups, respectively (P=0.02).ConclusionAflibercept and ranibizumab have the same efficacy in the treatment of DME in eyes with moderate visual loss but with less number of drug re-injection and less treatment burden with aflibercept (2.62±0.68 versus 3.03±0.95).

Posterior Subtenon's Capsule Triamcinolone Acetonide Injection for the Treatment of Diabetic Macular Edema.

To evaluate and compare the efficacy of posterior subtenon's triamcinolone injections versus grid laser photocoagulation (GLP) combined with posterior subtenon's triamcinolone injection in eyes with diabetic macular edema (DME). In this prospective clinical study, 42 eyes with DME that showed a decrease in visual acuity (VA) were included. The first group consisted of 22 eyes that received a posterior subtenon's injection of 40 mg of triamcinolone acetonide under topical anesthesia. The second group of 20 eyes received macular GLP applied 1 month after subtenon's triamcinolone acetonide (STTA) injection. All patients were evaluated at baseline and 1 day; 1, 2, 4, 6, and 8 weeks; and 3 and 6 months after injection. In some patients, injections were repeated after 3 months. The main outcome measures were VA, central macular thickness (CMT), intraocular pressure, cataract progression, and frequency of complications. The mean baseline CMT for Group I was 456.85 ± 56.90 μm. The mean baseline CMT for Group II was 455.66 ± 57 μm. In the first group, mean CMTs for second week, 8th week, 12th week, and 6th month were 258.15, 276.50, 280.05, and 433.30 μm, respectively. In the second group, mean CMTs for second week, 8th week, 12th week, and 6th month were 261.42, 272.76, 284.71, and 291.76 μm, respectively. Before treatment, in the first group, the mean best-corrected visual acuity (BCVA) measured using a Snellen chart was 0.19, while the first week, third, and sixth month BCVA means were 0.59, 0.57, and 0.41, respectively. Before treatment, BCVA in the second group was 0.17, while the first week, third, and sixth month means were 0.61, 0.64, and 0.60, respectively. Treatment complications included cataracts in 4 eyes and glaucoma in 1 eye. There is a temporary therapeutic effect of posterior subtenon's triamcinolone injection without laser photocoagulation. GLP improves VA and reduces the risk of recurrent macular edema after posterior STTA injection.

Changes in Choroidal Thickness After Panretinal Photocoagulation for Diabetic Retinopathy: A 12-Week Longitudinal Study.

To investigate the longitudinal changes in choroidal thickness of the eyes of diabetic retinopathy patients during 12 weeks after panretinal photocoagulation (PRP). This prospective, comparative study included 46 eyes undergoing four-session PRP. At baseline and 1, 4, 8, and 12 weeks after completion of the PRP treatments, subfoveal choroidal thickness (SFCT) was measured by using enhanced depth imaging optical coherence tomography. Also measured were central macular thickness (CMT) and best-corrected visual acuity (BCVA). The mean SFCT at baseline was 309 ± 77 μm, changing to 323 ± 78 μm, 315 ± 75 μm, 299 ± 68 μm, and 289 ± 71 μm at 1, 4, 8, and 12 weeks, respectively. This constituted a statistically significant increase at 1 week and a significant decrease at 12 weeks. The mean baseline CMT was 294 ± 92 μm, which increased significantly 1 week after PRP to 344 ± 123 μm, remaining higher at 4 weeks (340 ± 117 μm) and 8 weeks (318 ± 100 μm), but subsiding to baseline at 12 weeks (311 ± 96 μm). The mean BCVA at baseline and the last visit were 0.63 ± 0.28 logMAR and 0.53 ± 0.42 logMAR, respectively. There was no significant difference in BCVA between eyes with and without central-involved diabetic macular edema at all time points. Compared with the baseline, the mean BCVA dropped at 1 week and 4 weeks but recovered by 12 weeks. Choroidal thickness decreased 12 weeks after PRP, suggesting that PRP may reduce choroidal vascular permeability or cause atrophy of choroidal vessels over a 12-week period.

Use of intravitreal dexamethasone implant in patients with cataract and macular edema undergoing phacoemulsification.

To study the safety and efficacy of intravitreal dexamethasone implant in patients with cataract and macular edema undergoing phacoemulsification and intraocular lens (IOL) implantation. Twenty-four eyes with macular edema secondary to diabetic retinopathy (diabetic macular edema [DME]) and retinal vein occlusion (RVO) were retrospectively reviewed. These eyes underwent phacoemulsification with IOL implantation and intravitreal dexamethasone implant 0.7 mg at the same setting between September 2012 and September 2013. Demographic data, best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), surgical time, and complications were recorded. Twelve eyes had DME and 12 eyes had RVO (10 central RVO and 2 branch RVO). Median baseline logMAR BCVA was 1.0 (Snellen 20/200) and mean baseline CMT was 530.2 ± 218.9 µm. Median follow-up duration was 13 months. At last follow-up, median visual acuity improved significantly to 0.523 (Snellen 20/66) (p = 0.003) and CMT decreased to 300.7 ± 78.1 µm (p = 0.000). Median surgical time was 23 minutes. There were no intraoperative complications. In 12 eyes, macular edema recurred, requiring further treatment, and median time to recurrences was 21 weeks. One eye had raised IOP after second dexamethasone implant for recurrent macular edema. No major complication such as vitreous hemorrhage, retinal detachment, or endophthalmitis occurred. Combined cataract surgery with intravitreal dexamethasone implant seems to be safe and effective in treating patients with cataract and macular edema in this small case series. A larger prospective study with longer follow-up is necessary to demonstrate the long-term benefit of this combined procedure.

Effect of intravitreal bevacizumab for chronic, recurrent, or atypical central serous chorioretinopathy

AbstractPurpose To evaluate the efficacy of intravitreal bevacizumab injection (IVB) for the treatment of chronic, recurrent, or atypical central serous chorioretinopathy (CSC).Methods Forty‐nine eyes of 49 patients who were diagnosed with chronic, recurrent, or atypcial CSC and treated with intravitreal injection of 1.25 mg/0.05 ml bevacizumab, were included for this retrospective study. Best‐corrected visual acuity (BCVA) and central macular thickness (CMT) were analyzed at baseline, 3, 6, 9, and 12 months after initial IVB.Results Patients received the mean of 2.16±1.34 IVB during the mean follow‐up period of 11.8±7.4 months, and 20.4% of patients had recurrent episode after initial resolution of subretinal fluid in this period. The mean baseline BCVA was 0.27±0.26 logarithm of minimum angle of resolution, and the mean baseline CMT was 353 ± 129 um. BCVA was significantly improved to 0.16 ± 0.18 (P = 0.005) and 0.14 ± 0.12 (P = 0.000) at 3 and 6 months, respectively. However, the improvement of BCVA was not significant at 9 months and 12 months. CMT was significantly reduced throughout the follow‐up period and 216±101 um (P = 0.008) at 12 months.Conclusion Intravitreal bevacizumab injection may be an effective treatment option for patients with chronic, recurrent, or atypical CSC. Further prospective, long‐term studies are warranted.

Ranibizumab for idiopathic epiretinal membranes: A retrospective case series

PurposeTo study the effect of intravitreal ranibizumab on idiopathic epiretinal membranes (ERMs). MethodsA retrospective cohort study on a consecutive series of ranibizumab intravitreal injections for epiretinal membranes was performed. Four cases were identified by reviewing a claims database linked to electronic medical records. All patients received a total of three 0.05mg/0.05ml ranibizumab intravitreal injections at a monthly interval. The primary outcome measure was the final best-corrected visual acuity (BCVA) at the end of the injection series, and the final central macular thickness (CMT). ResultsAll four patients completed 3months follow-up after the last ranibizumab injection. The mean baseline CMT was 509microns (SD=111). A trend was noticed for reduction in CMT (Δ=41microns) P=0.08. Three patients improved by one line in their BCVA. The remaining patient maintained the same BCVA. No complications were noted. ConclusionIn this study, intravitreal injection of ranibizumab marginally reduced retinal thickness in four patients with minimal improvement in visual acuity. No safety concerns were noticed. Further basic science and clinical studies may be warranted to assess the role of vascular endothelial growth factor and the effect of ranibizumab on idiopathic epiretinal membranes.

Baseline central macular thickness predicts the need for retreatment with intravitreal triamcinolone plus laser photocoagulation for diabetic macular edema

PurposeTo identify baseline characteristics that predict the number of treatments with intravitreal triamcinolone acetonide (IVTA) plus laser photocoagulation needed to treat diabetic macular edema over a 2-year period.MethodsIndividual data from 42 eyes of 42 participants treated with IVTA plus laser photocoagulation for diabetic macular edema during a prospective, randomized, double-masked, placebo-controlled trial were used for this post hoc analysis. Baseline characteristics – age, gender, best-corrected visual acuity, glycosylated hemoglobin, phakic status, intraocular pressure, and central macular thickness (CMT) – were correlated with the number of IVTA plus laser treatments received during the 2 years of this study.ResultsThe median number of treatments received over the 2-year period was 2.5 (interquartile range 1.0–3.0), with 21 (50%) eyes needing three or more treatments. Eyes that received more IVTA plus laser treatments had a higher mean baseline CMT and eyes with a higher baseline CMT were more likely to receive three or more treatments (odds ratio 5.13, 95% confidence interval 1.75–15.04, P=0.003 per 100 μm increase in CMT). No significant relationship was found between other baseline characteristics and the number of IVTA plus laser treatments received.ConclusionHigher baseline CMT was strongly linked with receiving more IVTA plus laser treatments. These patients may be at higher risk of developing dose-dependent steroid-related adverse events, cataract progression, and intraocular pressure rise.