Reduction In Mean Central Macular Thickness Research Articles

Effectiveness of intravitreal ranibizumab for diabetic macular edema in vitrectomized versus non-vitrectomized eyes: a Meta-analysis.

To evaluate the effectiveness and safety of intravitreal ranibizumab (IVR) for diabetic macular edema (DME) in vitrectomized versus non-vitrectomized eyes. The PubMed, EMBASE, Web of Science, Cochrane, EBSCO were comprehensively searched for studies comparing vitrectomized and non-vitrectomized eyes with DME. Clinical outcomes of best-corrected visual acuity (BCVA), central macular thickness (CMT), the mean number of intravitreal injection and adverse events were extracted and analyzed. Six studies involving 641 eyes were included. Final visual gain significantly improved and CMT significantly reduced in vitrectomized eyes at 6mo and 12mo visits (P<0.05). Although the mean reduction in CMT among non-vitrectomized eyes was significantly greater than in vitrectomized eyes at the 6mo [mean difference (MD)=53.57, 95% confidence interval (CI): 28.03 to 78.72, P<0.0001] and 12mo (MD=49.65, 95%CI: 19.58 to 79.72, P=0.01), no significant difference was detected in improvement in BCVA at either 6mo (MD=0.05, 95%CI: -0.02 to 0.13, P=0.14) or 12mo (MD=0.03, 95%CI: -0.04 to 0.09, P=0.43). Injection number of ranibizumab in non-vitrectomized eyes was significantly less than that in vitrectomized eyes during 6-month period (MD=0.60, 95%CI: 0.16 to 1.04, P=0.008), while there was no statistically significant difference between the two groups during 12mo of follow-up. Evidence from current study suggests that IVR was useful for both vitrectomized group and non-vitrectomized group with DME. Although less reduction in macular thickness is found in vitrectomized group, visual improvement between two groups is similar.

Real-World Evidence of the Long-Term Effectiveness of 0.2 μg/Day Fluocinolone Acetonide Implant in Persistent and Recurrent Diabetic Macular Edema - A Single Center Study.

To report the long-term functional, anatomical and safety outcomes of 0.2 μg/day fluocinolone acetonide 0.19mg in patients with persistent or recurrent diabetic macular edema (DME). Retrospective, observational, single-center study of patients with recurrent or persistent DME. All patients received 0.2 μg/day of fluocinolone acetonide 0.19mg, and data were collected at baseline and months 1, 3, 6, 12, 24 and 36 after implantation. Outcomes measured included best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and safety outcomes. A total of 28 eyes from 28 patients were included. The mean age was 66.5 years (95% CI 62.8-70.2) with a mean duration of DME of 8.8 years (95% CI 7.7-10.0). Only two eyes were phakic. Mean follow-up was 25.4 months (95% CI 21.2-29.6). Mean BCVA at baseline was 48.6 ETDRS letters (95% CI 41.3-55.8) and improved as early as month 1 of follow-up with a mean gain in BCVA of 7.8 (95% CI 4.3-11.3) ETDRS letters (p<0.001). Statistically significant improvements in BCVA were also observed at months 6, 12 and 24. At baseline, patients had a mean CMT of 530.5µm (95% CI 463.0-598.0), and a decrease in CMT was observed, starting at the first month of follow-up (mean CMT reduction of -170.5µm, 95% CI -223.8- -117.1; p<0.001). Statistically significant decreases in CMT were also observed at months 6, 12, 24, and 36, with the maximum decrease observed at month 12 (p<0.001). Mean IOP at baseline was 16.4mmHg (95% CI 15.3-17.5) and nine eyes (32.1%) had an IOP ≥21mmHg during follow-up. Our results support the effectiveness and safety profile of fluocinolone acetonide. Although additional long-term real-world evidence is required, fluocinolone acetonide may represent a safe strategy for daily, low-dose, sustained and localized release to the posterior segment of the eye, providing both functional and anatomical benefits in DME.

Long term follow up of patients with MNV3 treated with intra-vitreal Aflibercept.

MNV3 or Retinal angiomatous proliferation is a subtype of neovascular age-related macular degeneration (nAMD). We present the 5 year long term visual and anatomical outcomes of patients with MNV3 lesions treated with intravitreal Aflibercept. This is a prospective study of treatment naïve patients with reading centre graded MNV3 lesions. After the loading phase, the patients received intravitreal Aflibercept as per the View study up to year 3, thereafter it was given on a prn basis. At each visit, best corrected visual acuity (BCVA) and optical coherence tomography (OCT) central macular thickness (CMT) was measured. Thirty one patients reached study completion. Mean BCVA of treated eyes had decreased by 0.6 ETDRS letters at the end of year 5 compared with baseline. At study completion, 81% of eyes had stable vision while 19% of eyes had gained 15 letters or more. At study end, 26% of eyes had BCVA of 6/12 or better, while 19% had lost 15 letters or more (all had central foveal photoreceptor loss). There was a maximal mean reduction in CMT of 164 microns (p = <0.0001) while 68% of maculae were fluid free at study completion. Eighty seven percent of treated eyes developed nascent GA, of which in 74% of eyes was involving the fovea. Despite initial improvement in mean BCVA, the improvement in BCVA was not maintained despite good overall control of the MNV3 lesions. The loss of BCVA was most likely due to the majority of eyes developing centre involving macular atrophy.

CENTRAL MACULAR THICKNESS AFTER COMBINED THERAPY OF BEVACIZUMAB INTRAVITREAL INJECTION AND TOPICAL DICLOFENAC COMPARED WITH BEVACIZUMAB INTRAVITREAL INJECTION ALONE IN DIABETIC MACULAR EDEMA

Introduction: To evaluate whether the combination of diclofenac eye drops and bevacizumab intravitreal injection would provide additional benefits over bevacizumab alone in the treatment of naïve diabetic macular edema (DME).&#x0D; Methods: A total of 43 patients were enrolled consecutively and randomized into two groups to receive combination treatment with intravitreal bevacizumab and topical diclofenac (group 1) or bevacizumab alone (group 2). Group 1 patients received single bevacizumab intravitreal injection and got self-administered diclofenac eye drop four times daily for one month. Group 2 patients received single bevacizumab intravitreal injection alone. Outcome data were obtained from patient visits at baseline and at 1 month after bevacizumab intravitreal injection. All patients underwent measurement of best corrected visual acuity (BCVA), a complete eye examination, and measurement of central macular thickness (CMT).&#x0D; Result: The mean reduction in CMT in the combination group was 130.42±32.57 µm (p&lt;0.01), while in the bevacizumab alone group the reduction was 141.38±45.27 µm (p&lt;0.01), there is no significant difference between the two groups (p=0.866). The mean improvement of BCVA was 0.32±0.10 log Mar in the combination group and 0.26±0.12 in group 2, there is no significant difference between the two groups (p=0.691). There was no adverse ocular event in the two groups.&#x0D; Conclusion: In patients with naïve DME, adding diclofenac eye drop as adjuvant of bevacizumab intravitreal injection are less likely to have a meaningful effect on reducing the central macular thickness.&#x0D; Keywords: Diabetic macular edema, NSAID, diclofenac, anti-VEGF, bevacizumab, central macular thickness

Prognostic biomarkers of chronic diabetic macular edema treated with a fluocinolone acetonide intravitreal implant

Background: This study aimed to investigate retinal imaging biomarkers, such as disorganization of the retinal inner layers (DRIL) and/or ellipsoid zone (EZ) disruption by spectral domain optical coherence tomography (SD-OCT), and functional outcomes in eyes treated with 0.2 µg/day of a fluocinolone acetonide intravitreal implant (FAc) after an insufficient response to previous treatments.&#x0D; Methods: This was a retrospective comparative study of 18 eyes (15 patients) with persistent and/or recurrent diabetic macular edema (DME) treated with FAc. Eyes were divided according to the number of prior intravitreal treatments: group 1 (n = 8) with less than or equal to 6 injections (early switch) and group 2 (n = 10) with &gt; 6 injections (late switch). Outcomes included percentage of eyes with DRIL and/or EZ disruption at baseline and analysis of the best corrected visual acuity (BCVA) using ETDRS letters, central macular thickness (CMT), DRIL, and EZ disruption at the last observation.&#x0D; Results: Group 2 revealed a significantly higher percentage of DRIL and/or EZ disruption than group 1 (P &lt; 0.05). At the last observation, group 1 revealed a higher percentage of eyes achieving vision stability/improvement, gaining greater than or equal to15 letters, and achieving greater than or equal to 70 letters (P &gt; 0.05 for all comparisons). The mean BCVA gain was 8.8 and 0.7 letters for groups 1 and 2 (P = 0.397). Both groups revealed a significant mean CMT reduction (&gt;20% reduction from the baseline value), without a significant statistical difference between them (P = 0.749). After treatment, most eyes from both groups showed resolution of DRIL and EZ disruption.&#x0D; Conclusions: Patients with DME presenting with a lower percentage of DRIL and/or EZ disruption at baseline had better functional outcomes, supporting the possible benefit of an early switch to FAc after insufficient response to previous treatments. Future randomized studies with a larger patient cohort are warranted to confirm our conclusions.&#x0D; How to cite this article: Lopes BO, Brizido MS, Aerts F, Pina SM, Simoes PS, Miranda MI. Prognostic biomarkers of chronic diabetic macular edema treated with a fluocinolone acetonide intravitreal implant. Med Hypothesis Discov Innov Ophthalmol. 2021 Summer; 10(2): 50-58. https://doi.org/10.51329/mehdiophthal1421

Prospective trial of treat-and-extend regimen with aflibercept for branch retinal vein occlusion: 1-year results of the PLATON trial.

To evaluate the functional and anatomical outcomes of a treat-and-extend (TAE) regimen with aflibercept for treatment-naive macular edema (ME) secondary to branch retinal vein occlusion (BRVO). This was a prospective, multicenter, noncomparative, open-label clinical trial. Forty-eight eyes of 48 patients received three monthly intravitreal aflibercept injections prior to the TAE regimen. However, if the best-corrected visual acuity (BCVA) was ≥ 20/20 and the central macular thickness (CMT) was < 250 μm during the loading phase, the patient immediately proceeded to the TAE regimen. The treatment interval was adjusted by 4 weeks based on changes in CMT. The primary outcome was the mean change in BCVA from baseline to 52 weeks. The mean change in BCVA was 23.6 ± 14.2 letters. The proportion of patients with BCVA gain ≥ 15 letters was 77.1% at 24 weeks and 72.9% at 52 weeks. The mean reduction in CMT was 326.2 ± 235.6 μm at 24 weeks and 324.2 ± 238.0 μm at 52 weeks. The mean number of injections was 6.7 ± 1.2 (range: 6-11, all patients received three monthly intravitreal aflibercept injections) over 52 weeks, and 34 patients (70.8%) reached the maximal extension interval of 16 weeks at 52 weeks. The TAE regimen using aflibercept for ME secondary to BRVO, which has a treatment interval of up to 16 weeks, showed comparable efficacy to the fixed-dosing regimen along with reduced treatment burden.

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.

Early effect of simultaneous intravitreal dexamethasone and bevacizumab combination treatment in patients with persistent diabetic macular edema

To report the early effect of simultaneous intravitreal dexamethasone and bevacizumab combination treatment in patients with persistent diabetic macular edema (DME). In this single-center prospective non-randomized study, 65 eyes of 59 patients with persistent DME were included. In the combined group (Group 1), we treated 35 eyes of 29 persistent DME patients with a simultaneous combination of intravitreal dexamethasone and bevacizumab, and in the control group (Group 2), we treated 30 eyes of 30 patients with intravitreal bevacizumab. Changes in Best Corrected Visual Acuity (BCVA), Central Macular Thickness (CMT) and Intraocular Pressure (IOP) from the initial visit to each subsequent follow-up visit (1st, 2nd and 3rd months) were recorded. In Group 1, the mean baseline Early Treatment Diabetic Retinopathy (ETDRS) BCVA letter score was 44.1±19.3 (range 20-51), improving significantly to 58.8±18.2 (range 42-73) in the first month (P<0.05), 57±19.2 (range 40-72) in the second month (P<0.05) and 55.4±18.4 (range 34-71) in the third month (P<0.05). In Group 2, the mean pre-injection BCVA ETDRS letter score was 43.3±18.8 (range 20-56) and did not improve significantly; the letter score was 44.3±18.1 (range 20-49) in the third month. In Group 1, the mean BCVA change from baseline to the 3rd month was 11.3 ETDRS letters. In Group 2, the mean BCVA change from baseline to the 3rd month was 1 ETDRS letter. In Group 1, the mean reduction in CMT from baseline was -142.25μm. In Group 2, the mean reduction in CMT from baseline was -17.30μm. In Group 1 at the third month, 12 (34.2%) eyes with a CMT>300μm needed an additional injection. No serious ocular or systemic side effects occurred in any patient. Simultaneous intravitreal dexamethasone and bevacizumab combination treatment is effective and can be used safely in persistent DME.

Effects of Oral Vitamin D Supplement Therapy on Clinical Outcomes of Intravitreal Bevacizumab in Diabetic Macular Edema.

PurposeTo assess the effects of oral vitamin D supplement therapy on clinical outcomes of intravitreal bevacizumab (IVB) injections in patients with diabetic macular edema (DME).Methods Seventy-one patients with center-involving DME received IVB injections three times monthly. Cases with serum 25-hydroxyvitamin D (25(OH)D) levels 30 ng/ml were divided into treatment and control groups. The treatment group received 50000 IU of oral vitamin D once a week for eight weeks. One month after the third IVB injection, changes in the best-corrected visual acuity (BCVA) and central macular thickness (CMT) were analyzed for each group.ResultsThirty-seven patients had sufficient levels of 25 (OH) D, while 34 patients had insufficient levels. Nineteen cases with deficient levels of 25(OH)D were treated with oral vitamin D, while 15 patients were assigned to the control group. The mean of serum 25(OH)D in patients was 27.9 ng/ml [mean 20.3 5.4 and 17.3 5.4 ng/ml in control and treatment groups, respectively (P = 0.231)]. After three IVB injections, BCVA improved significantly in each group, but the difference between the study groups was not statistically significant. CMT decreased significantly in all the groups. The mean CMT reduction was more prominent in the vitamin D-treated group, but the difference between groups did not reach statistical significance (P = 0.29).Conclusion In DME patients with vitamin D deficiency, vitamin D supplement therapy had some beneficial effects on CMT reduction following three injections of IVB; nevertheless, these effects were not statistically significant. Definite conclusion needs further prospective studies with a larger sample size.

Prognostic biomarkers of chronic diabetic macular edema treated with a fiuocinolone acetonide intravitreal implant.

This study aimed to investigate retinal imaging biomarkers, such as disorganization of the retinal inner layers (DRIL) and/or ellipsoid zone (EZ) disruption by spectral domain optical coherence tomography (SD-OCT), and functional outcomes in eyes treated with 0.2 µg/day of a fluocinolone acetonide intravitreal implant (FAc) after an insufficient response to previous treatments. This was a retrospective comparative study of 18 eyes (15 patients) with persistent and/or recurrent diabetic macular edema (DME) treated with FAc. Eyes were divided according to the number of prior intravitreal treatments: group 1 (n = 8) with ≤ 6 injections (early switch) and group 2 (n = 10) with > 6 injections (late switch). Outcomes included percentage of eyes with DRIL and/or EZ disruption at baseline and analysis of the best corrected visual acuity (BCVA) using ETDRS letters, central macular thickness (CMT), DRIL, and EZ disruption at the last observation. Group 2 revealed a significantly higher percentage of DRIL and/or EZ disruption than group 1 (P < 0.05). At the last observation, group 1 revealed a higher percentage of eyes achieving vision stability/ improvement, gaining ≥ 15 letters, and achieving ≥70 letters (P > 0.05 for all comparisons). The mean BCVA gain was 8.8 and 0.7 letters for groups 1 and 2 (P = 0.397). Both groups revealed a significant mean CMT reduction (> 20% reduction from the baseline value), without a significant statistical difference between them (P = 0.749). After treatment, most eyes from both groups showed resolution of DRIL and EZ disruption. Patients with DME presenting with a lower percentage of DRIL and/or EZ disruption at baseline had better functional outcomes, supporting the possible benefit of an early switch to FAc after insufficient response to previous treatments. Future randomized studies with a larger patient cohort are warranted to confirm our conclusions.

The effects of intravitreal triamcinolone acetonide in diabetic macular edema refractory to anti-VEGF treatment.

To investigate the efficacy and safety of primary intravitreal triamcinolone acetonide (IVTA) in eyes affected by diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy. Retrospective observational study METHODS: The medical records of patients who attended our clinic from March 2013 to September 2018 with refractory macular were reviewed. We included the patients who were injected at least one IVTA and completed 6 months of observation. Best-corrected Snellen visual acuity (VA), central macular thickness (CMT), intraocular pressure (IOP), and adverse events (AEs) were examined at baseline and at 1 month, 2 months, 3 months, and 6 months. Sixty-four eyes of 54 subjects were included. The mean VA was improved significantly at all time points compared to pre-treatment (P < 0.0001), with the greatest mean improvement at 1 month (0.3 logMAR). The reduction in mean CMT was also significant at all follow-up examinations compared to baseline (P < 0.0001), with the greatest decrease at 1 month (113.68 ± 53.78 μm). A poorer VA before injection was a factor that influenced visual gain 1 month post treatment (0.247 logMAR units/unit increase in baseline VA, P = 0.006). The most common AE associated with IVTA treatment was elevated IOP (11 eyes), observed significantly more often after IVTA injections containing a preservative (25.8%) than after those that were preservative-free (9.1%) (P = 0.033). IVTA injection can be an alternative steroid treatment for DME refractory to anti-VEGF therapy.

Outcome following single intravitreal injection of ranibizumab in branch retinal vein occlusion patients: a single centre experience

Objective:To find out outcome following single intravitreal injection of ranibizumab in branch retinal vein occlusion (BRVO) patients in a government hospital in the capital of Odisha. Methods: This study was a prospective interventional study of 18 months duration, done from August 2017 to February 2019 which included 21 cases of BRVO. Thorough history was taken and detail ophthalmological evaluation was done. Best corrected visual acuity (BCVA) was examined with Snellen’s chart and central macular thickness (CMT) was measured using optical coherence tomography (OCT). Routine blood tests were done. Intravitreal injection of ranibizumab 0.5 mg in 0.05 ml was given. BCVA and CMT was measured at 1 day, 1 week, 1 month and 3 months follow up visit. Results: Mean age was 55.29 ± 16.86 yrs. Male: female ratio was 3.2:1. 33. About 3% patients presented within 1 month of onset of symptoms. Diastolic blood pressure of ≥ 90 was found in 81% patients. 90.5% showed improvement at 1 week post-operatively.At post-operative day 1 CMT was significantly decreased (p= 0.0011). Reduction in mean CMT at post-operative day 7 was >270 µ. Conclusion: Single intravitreal injection of ranibizumab 0.5 mg in 0.05 mlcauses significant increase in vision and significant reduction of central macular thickness in patients with branch retinal vein occlusion.

Intravitreal Aflibercept for Retinal Angiomatous Proliferation: Results of a Prospective Case Series at 96 Weeks

Introduction: Retinal angiomatous proliferation (RAP) is a subtype of neovascular age-related macular degeneration (nAMD). Untreated, the lesions are thought to be aggressive and lead to a poor visual outcome. Despite some limitations, studies reporting the treatment of RAP lesions with the intravitreal anti-VEGF drugs ranibizumab and bevacizumab have demonstrated variable but generally favourable responses. More recently, aflibercept has been licensed for the treatment of nAMD and may offer some advantages over other agents. We present the visual and anatomical outcomes at 96 weeks of patients with RAP lesions who were treated with intravitreal aflibercept, according to the pivotal VIEW study nAMD treatment protocol. Methods: This is a prospective study of treatment-naïve patients with Reading Centre-graded RAP lesions. The patients received aflibercept every 8 weeks, after 3 initial monthly injections, up to and including week 48. During weeks 52–96, patients received injections at least every 12 weeks, with monthly evaluations for interim injections if they fulfilled the retreatment criteria. At each visit, best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) central macular thickness (CMT) were measured. Results: Forty-six patients reached study completion at week 96. Mean BCVA had improved by 6.0 (standard deviation [SD] 7.9) and 4.8 (SD 7.4) ETDRS letters at 52 (p = 0.003) and 96 (p = 0.02) weeks, respectively, from a baseline of 57.3 (SD 12.0) letters. At 52- and 96-week time points, 45/46 (98%) and 41/46 (89%) of patients, respectively, had maintained their vision (<15 letters of BCVA lost). At the 96-week time point, 13/46 (28%) of patients had gained ≥15 letters and also demonstrated a mean reduction in CMT of 162 μm (SD 106) (p = <0.0001), with 72% of maculae being fluid-free. Using univariate analysis, we found no significant difference between any of the visual outcome measures in this study and the pivotal VIEW study; the mean number of injections required and change in CMT were also similar. Conclusions: In this study, we present the 96-week results, of the largest series to date, of patients treated prospectively with aflibercept for RAP using the VIEW protocol. We show that they benefited from treatment to a degree similar to those with type 1 and 2 nAMD.

Comparison of the effect of ranibizumab and dexamethasone implant on serous retinal detachment in diabetic macular edema

To compare the efficacy of intravitreal ranibizumab (IVR) and intravitreal dexamethasone implant (IDI) on neurosensory retinal detachment (SRD) associated with diabetic macular edema (DME) in the early treatment period. This was a retrospective, interventional, case-control study. After three monthly loading doses of IVR or an initial IDI injection, the changes in best-corrected visual acuity (BCVA), central macular thickness (CMT) on OCT, and presence and height of SRD were evaluated. The IVR and IDI groups consisted of 101 and 35 eyes, respectively. The mean changes in CMT in the IVR and IDI groups were 204.4±176.6 and 311.4±163, respectively (P<0.001). The mean changes in SRD height in the IVR and IDI groups were 133.6±92.1 and 168.6±103.9μm, respectively. The decrease in SRD height was significantly greater in the IDI group than in the IVR group (P=0.002). The SRD resolved completely in 72.2% and 71.4% of the patients in the IVR and IDI groups, respectively (P=0.9). The mean reduction in CMT and SRD height was greater in the IDI group than in the IVR group. There was a negative correlation between baseline best-corrected visual acuity (BCVA) and SRD height and also between BCVA and CMT.

Efficiency of fenofibrate in facilitating the reduction of central macular thickness in diabetic macular edema.

Purpose:The purpose of this study is to study the benefit of addition of oral fenofibrate to the current regimen of diabetic macular edema (DME) management and quantify its effect on macular thickness and visual function in DME.Methods:Fifty-three eyes of 50 patients were randomized into treatment (Group A) (oral fenofibrate 160 mg/day) and control groups (Group B). Both groups underwent treatment of DME as per the standard treatment protocol of our hospital including intravitreal injections (anti-vascular endothelial growth factor/steroid) and grid laser. Patients were followed up every 2 months to note the visual acuity and central macular thickness (CMT) for 6 months.Results:Our groups were matched with respect to age (P = 0.802), mean diabetic age (P = 0.878), serum HbA1C levels (P = 0.523), and serum triglyceride levels (P = 0.793). The mean reduction in CMT was 136 μ in Group A and 83 μ in Group B at the end of 6 months. This difference was statistically significant (P = 0.031). Visual acuity improvement was 0.15 in Group A and 0.11 in Group B at the end of 6 months (P = 0.186). On subgroup analysis in Group A, we found that there was no difference in reduction of CMT between hypertensives and normotensives (P = 0.916), in patients with normal triglyceride levels and increased triglyceride levels (P = 0.975).Conclusion:Addition of fenofibrate to the standard protocol of DME management seems to facilitate reduction of CMT and probably have an added benefit on the visual functions.

Dexamethasone Intravitreal Implant in the Treatment of Persistent Uveitic Macular Edema in the Absence of Active Inflammation

To examine the observational effectiveness of the dexamethasone (DEX) intravitreal implant (Ozurdex; Allergan, Inc., Irvine, CA) in the treatment of noninfectious uveitic macular edema in patients with otherwise quiescent uveitis. Retrospective chart review. A total of 27 consecutive patients with persistent macular edema resistant to standard short-term therapy despite quiescent noninfectious intermediate or posterior uveitis. Each patient was treated with a DEX 0.7 mg implant. Primary outcome measure was resolution of macular edema 1 month after injection as measured by decrease in central macular thickness (CMT). Secondary outcome was change in visual acuity 1, 2, and 3 months after injection. A total of 27 eyes of 27 patients were included for analysis. One eye was randomly selected for 6 of these patients who received bilateral DEX implants. There was a statistically significant reduction in mean CMT 1month after DEX implantation (mean, 278.9 μm; range, 206-352 μm) compared with baseline (mean, 478.7 μm; range, 330-667 μm) (P < 0.0001). There was a statistically significant improvement in visual acuity at 3 months (logarithm of the minimum angle of resolution [logMAR] 0.41; 20/51) compared with baseline (logMAR 0.60; 20/80) (P= 0.0005). There were no major complications after DEX implantation. The DEX implant resulted in a statistically significant improvement in mean CMT and visual acuity without any serious adverse events.

A Pilot Study of Intravitreal Diclofenac versus Intravitreal Triamcinolone for Uveitic Cystoid Macular Edema

Purpose: To compare the effect of intravitreal diclofenac (IVD) versus intravitreal triamcinolone (IVT) on refractory uveitic cystoid macular edema (CME).Methods: In this pilot randomized clinical trial, 15 eyes were randomly assigned to an IVD group, patients (8 eyes) who received a single intravitreal injection of diclofenac (500 μg/0.1 mL), and an IVT group (7 eyes), cases who received a single intravitreal injection of triamcinolone (2 mg). Change in best-corrected VA in logMAR at week 36 was the primary outcome measure. Secondary outcomes included changes in best-corrected visual acuity (BCVA) at 12 and 24 weeks, central macular thickness (CMT), macular leakage, and potential injection-related complications.Results: In the IVD group, BCVA was more than the baseline values in 4 eyes at 36 weeks; however, within-group analysis disclosed no statistically significant changes in the mean BCVA in this group. Nonetheless, in the IVT group, mean BCVA improved significantly at 12, 24, and 36 weeks compared to the baseline values. It was 0.86 ± 0.37 at baseline and 0.63 ± 0.48, 0.62 ± 0.42, and 0.43 ± 0.49 logMAR at 12, 24, and 36 weeks, respectively. Mean CMT reduction diminished also significantly only in the IVT group. Nevertheless, comparing the mean BCVA and CMT changes, macular leakage, and the occurrence of any injection-related complications, no significant difference was observed between the groups at any of the follow-up visits.Conclusion: This pilot study demonstrated the superiority of IVT over IVD in the treatment of refractory uveitic CME regarding both functional and anatomical outcomes. Further studies are warranted to confirm potential benefit of IVD observed in this study.

Anatomic and Functional Outcome of Triamcinolone-assisted 23-gauge Vitrectomy in Vitreomacular Traction Syndrome

Purpose: To evaluate the outcomes of patients with vitreomacular traction syndrome (VMT) treated with triamcinolone acetonid (TA) assisted 23-gauge (23-G) transconjunctival sutureless vitrectomy.Methods: Restrospective, case series. The medical charts of 13 eyes of 13 consecutive patients with VMT who underwent 23-gauge transconjunctival pars plana vitrectomy were reviewed. All patients had at least six-month follow-up. The main outcome parameters were changes in best corrected visual acuity (BCVA) and central macular thickness (CMT) between the baseline and postoperative follow- up examinations performed at the first, third, and sixth months after the surgery.Results: The mean follow-up period was 7 (range 6–15) months. The mean preoperative BCVA was 1.3±0.4 (logmar). The final BCVA was 0.5±0.3 (logmar) (p = 0.001). The mean CMT was 429±85 µm at baseline, which was significantly reduced to 255±47 µm at the final follow-up visit (p = 0.001). The mean CMT reduction was 174±101 (range: 32–348) µm. No postoperative complications were seen such as endophthalmitis, retinal detachment, hypotony, or glaucoma.Conclusion: Triamcinolone assisted 23-G transconjunctival sutureless vitrectomy is an effective and safe surgical technique in the management of VMT syndrome. Further studies with large case series are needed.

Intravitreal Triamcinolone Injection as an Adjuvant to Standard Laser Therapy in Management of Proliferative Diabetic Retinopathy

Purpose: To evaluate efficacy and safety of combined intravitreal triamcinolone acetonide (IVTA) injection plus panretinal photocoagulation (PRP) in comparison with PRP in proliferative diabetic retinopathy (PDR). Methods: 38 eyes of nineteen patients with PDR were enrolled. One eye of each patient was randomly selected to undergo IVTA injection one week prior to PRP session (IVTA eye), and contralateral eye treated with PRP alone (control eye). Patients were followed at 1, 4 and 6 months after treatment. Main outcome measures included change in logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA), central macular thickness (CMT) and complications. Results: Mean baseline logMAR BCVA was 0.41±0.36 (IVTA eyes) and 0.36±0.30 (control eyes). At 6 months, Mean change of visual acuity to logMAR BCVA was - 0.054±0.114 (IVTA eyes) and 0.053±0.145 (control eyes) (p=0.02). Mean baseline CMT was 274.5±61.7 µm (IVTA eyes) and 246.7±74.7 µm (control eyes). Injected eyes showed significant reduction in mean CMT at all visits. However, there was no significant difference for CMT between IVTA and control eyes at all visits. Significant reduction of CMT in IVTA eyes was observed at 1 month from 319.2±79.1 to 260.5±78.5 (p=0.024). At 6 months, CMT reduction was still significant in IVTA eyes as compared with baseline values (p=0.048). In control eyes, CMT was not significantly reduced at 1 and 6 months of treatment. Conclusions: IVTA injection is a relatively safe method which might have prophylactic role against visual acuity exacerbation and macular edema secondary to PRP in PDR eyes.

Intravitreal Ranibizumab for Myopic Choroidal Neovascularization: Factors Predictive of Visual Outcome and Need for Retreatment

To identify predictive factors for visual outcome and need for retreatment after treating myopic choroidal neovascularization (CNV) with ranibizumab. A prospective interventional case series. Sixty-seven eyes of 67 patients with myopic CNV were treated with 3 intravitreal ranibizumab injections given monthly. Best-corrected visual acuity (BCVA) and optical coherence tomography-determined central macular thickness (CMT) were recorded monthly during follow-up. Fluorescein angiography changes and the number of injections needed were also assessed. Mean follow-up was 15.9 months. Mean BCVA improved by 7.8 letters after the first injection, 12.5 letters after 3 injections, and 12 letters by end follow-up. In 53 eyes (79.1%), BCVA improved; 40.3% gained more than 15 letters. No differences were detected in visual outcome between treatment-naïve and previously treated patients. Myopic CNV area and greatest linear dimension had diminished at the study end. The mean reduction in CMT was 93.6 μm. The mean number of injections given was 4.2. A total of 53.7% of eyes received only 3 injections. Through regression analysis, baseline BCVA (P = .006) and myopic CNV location (P = .026) were significantly correlated with BCVA at the end of follow-up. Myopic CNV location (P = .023) and prior treatment (P = .047) were significantly linked to the number of injections given. No major complications arose. An initial treatment regimen of 3 monthly ranibizumab injections seems effective and safe to treat myopic CNV. Baseline BCVA and myopic CNV location emerged as predictive factors for visual outcome. A need for retreatment was associated with myopic CNV location and prior treatment.