Median Central Macular Thickness Research Articles

1-Year real-world outcomes of faricimab in previously treated neovascular age-related macular degeneration.

Faricimab, a bispecific antibody targeting VEGF-A and angiopoietin-2, has shown promise in treating neovascular age-related macular degeneration (nAMD). This study evaluates 1-year outcomes of faricimab in treatment-experienced nAMD patients. This single-centre retrospective cohort study included patients previously treated for nAMD who switched to faricimab between November 2022 and March 2024. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and treatment intervals were assessed at baseline, 6, and 12 months. One hundred eighty-four patients (215 eyes) were included. Patients had received a median of 18 (interquartile range [IQR] 10-28.5) anti-VEGF injections per eye over an average of 5.02 ± 11.82 years before switch. An average of 8.63 ± 2.2 faricimab injections were administered per eye over an average follow-up of 12.19 ± 2.70 months. Median BCVA decreased from 70 ETDRS letters (IQR 55-76) at baseline to 62 (IQR 47-76) at 12 months (p = 0.0038). Median CMT improved from 259.5 μm (IQR 223-299.75) at baseline to 232 μm (202.0-272.5) at 12 months (p < 0.0001). At the last follow-up, 40.2% of eyes were dry on OCT. The median dosing interval doubled from 4 weeks (IQR 4-4) to 8 weeks (IQR 6-10) with faricimab (p < 0.0001). 47.4% and 16.3% of eyes achieved treatment intervals of ≥8-12 weeks and ≥12 weeks, respectively. Three events of uveitis were noted following the loading phase. This real-world study demonstrates that faricimab maintains vision and achieves significant anatomical improvements in treatment-experienced nAMD patients. The extended treatment intervals could significantly reduce the burden on patients and healthcare resources.

Targeting the Tie-2 Receptor With Faricimab in Central Serous Chorioretinopathy: A Case Series Motivated by a Genetic Finding

PurposeTo investigate the effects of faricimab, a bispecific antibody targeting VEGF and Ang-2 (thus increasing Tie-2 activity), in patients with CSC based on a recent genetic study that implicated Tie-2 signaling in CSC pathophysiology. DesignA retrospective interventional multicenter case series. MethodsWe included patients with chronic CSC (persistent or recurrent SRF for ≥6 months) who received at least one faricimab 6mg injection between January 1 2022 and April 1 2024. Study sites included Massachusetts Eye and Ear and University of California San Francisco. Patients with evidence of a choroidal neovascular membrane on color photos, optical coherence tomography (OCT) and/or fluorescein angiography were excluded. 16 eyes (15 patients) met the inclusion criteria. The median central macular thickness at each visit from 52 weeks before to 52 weeks after the first faricimab injection was calculated using automated Heidelberg Spectralis ETDRS subfield measurements. ResultsPrior to treatment with faricimab, CSC had been diagnosed a median of 4.1 years (range 0.9–8) earlier and SRF (and intraretinal fluid [IRF] in a subset) had been continuously present for a median of 30 weeks (range 9–257). Decreases in macular thickness were observed in 14/16 eyes after the first faricimab injection and in 14/16 eyes in the full follow-up period compared with prior, 10 of which experienced complete resolution of SRF following the start of the first series of injections at a median of 4 weeks (range 2—25). One eye worsened after the second injection. The median improvement in macular thickness was 40μm [range -3 to 89.5] (P=0.0007). Upon review of OCT images, reductions in macular thickness were consistent with reductions in SRF and/or IRF. Visual acuity improved by 2 lines or more in 6/16 eyes. ConclusionsIn a retrospective case series of patients with chronic CSC and longstanding SRF, we observed improvement in macular thickness after intravitreal faricimab. While the small number of patients and variable natural history of CSC preclude definitive conclusions, a randomized controlled trial seems warranted.

Functional and structural characteristics in patients with type 3 macular neovascularisation treated with anti-VEGF. Three-year results in real world settings.

To evaluate the long-term anatomical and functional outcomes of anti-Vascular Endothelial Growth Factor intravitreal injections (anti-VEGF IVI) in patients with type 3 macular neovascularisation (MNV) in real-world settings. Retrospective review of patients with type 3 MNV who received anti-VEGF IVI between 2013 and 2020. Primary outcomes were best corrected visual acuity (BCVA) and central macular thickness (CMT). Secondary outcome was the development of new-onset of foveal-involving geographic atrophy (GA) and disciform scars. We identified 59 eyes from 48 British patients that met the inclusion criteria. Treatment with anti- VEGF IVI resulted in a statistically significant reduction in median CMT, which was maintained throughout the study period. At 36 months, 24 eyes showed more than 50 μm reduction in CMT, 7 eyes remained stable and only 2 eyes showed an increase in CMT by more than 50μm compared to the baseline. At year three, deterioration was noticed in most eyes (52.78%) and vision remained stable or improved in 47.22% of the eyes. However, the median BCVA was not statistically significant different compared to baseline. During the study period new onset of macula-involving atrophy or scar was noted in 10.2% and 4.3% of the eyes, respectively. In this real-world study, anatomic and functional improvement were recorded 12-months post anti-VEGF IVI in type 3 MNV. Despite sustained anatomical improvement, vision returned back to baseline levels at 36-months. The development of GA and macular scar was only partially responsible for this outcome suggesting a more severe nature of this form of nAMD.

Central retinal artery occlusion without cherry-red spots

BackgroundCherry-red spots are a very important sign for the clinical diagnosis of central retinal artery occlusion (CRAO). We retrospectively summarized the clinical manifestations of CRAO and analysed the causes and characteristics of CRAO without cherry-red spots. In this study, we explored a diagnostic method for CRAO without cherry red spots.MethodsSeventy patients (70 eyes) with CRAO were examined retrospectively. Corrected distance visual acuity, fundus photos, FA and OCT images were collected at the first outpatient visit. The causes of CRAO without cherry-red spots were analysed through fundus photos. The incidence of increased hyperreflectivity of the inner retina, central macular thickness (CMT) and arteriovenous transit time in patients with and without cherry-red spots were compared.ResultsFundus examination showed posterior retinal whitening in 57 cases (81.43%) and cherry-red spots in 39 cases (55.71%). Thirty-one patients presented at the first outpatient visit without cherry-red spots. The reasons for the absence of cherry-red spots included leopard fundus (32.26%), retinal vein occlusion (25.81%), no obvious inner retinal coagulative necrosis (19.35%), ciliary retinal artery sparing (12.90%), high macular oedema (9.68%) and cherry-red spot enlargement (3.23%). OCT revealed increased hyperreflectivity of the inner retina in 67 CRAO patients (95.71%). All 3 patients without increased hyperreflectivity of the inner retina did not present with cherry-red spots at the first visit. The median CMT in patients without cherry-red spots was 166.00 μm, while the median MCT in patients with cherry-red spots was 180.00 μm; there was no significant difference between these two groups (P = 0.467). FA showed delayed arteriovenous transit time > 23 s in 20 patients (28.57%), > 15 s in 43 patients (61.43%) and no delay in 27 patients (30.77%). The median arteriovenous transit time in patients without cherry-red spots was 19.00 s, while it was 18.00 s in patients with cherry-red spots; there was no significant difference between these two groups (P = 0.727).ConclusionsThere are multiple factors that could cause the absence of cherry-red spots in CRAO. The use of OCT to observe increased hyperreflectivity of the inner retina is the most effective imaging method for the early diagnosis of CRAO without cherry-red spots.

Visual function and retinal morphological changes after single suprachoroidal delivery of fluocinolone acetonide (Iluvien®) implant in eyes with chronic diabetic macular edema

BackgroundTo assess the efficacy and safety of supra-choroidal (SC) Iluvien in the management of chronic diabetic macular edema (DME).MethodsA retrospective interventional non-comparative consecutive case series including patients with chronic DME who received an SC Iluvien implant. All patients had persistent central macular thickness (CMT) ≥ 300µ after previous treatment with anti-vascular endothelial growth factor (VEGF) agents or laser photocoagulation. The main outcome measures were improvement of best-corrected visual acuity (BCVA), reduction of CMT, and detection of ocular hypertension/glaucoma or cataract formation. Friedman’s two-way ANOVA was used to analyze BCVA, intraocular pressure (IOP), and DME across different time points. P-value = 0.05.ResultsThe study included 12 eyes of 12 patients. Six patients (50%) were males. The median age was 58 years (range 52–76 years). The median duration of DM was 13 years (range 8–20 years). Ten patients (83.3%) were phakic and 2 patients (17%) were pseudophakic. The median pre-operative BCVA was 0.07 (range 0.05–0.8). The median pre-operative CMT was 544µ (range 354–745µ). The median pre-operative IOP was 17 mmHg (range 14-21mmHg). The median follow-up period was 12 months, range (12–42). Post-operatively, the median final BCVA was 0.15 (range 0.03-1), p 0.02, the median CMT was 404µ (range 213–747), p 0.4 and the median IOP was 19.5 mmHg (range 15–22), p 1. Two out of 10 phakic patients (20%) developed nuclear sclerosis grade I by 12 months. Six patients (50%) developed a transient rise in IOP < 10 mmHg from the baseline that resolved within 3 weeks with antiglaucoma drops.ConclusionSC Iluvien is potentially effective in improving visual function, reducing macular edema, and reducing the incidence of steroid-induced cataracts and glaucoma.

Comparison of Intravitreal Dexamethasone Implant and Intravitreal Ranibizumab Efficacy in Younger Patients with Branch Retinal Vein Occlusion.

This study aimed to compare the effects of dexamethasone (DEX) implants and ranibizumab (RAN) injections in younger patients with macular edema due to branch retinal vein occlusion (RVO) in a 6-month follow-up. The treatment-naive patients with macular edema secondary to branch RVO were included retrospectively. Medical records of patients who were treated with intravitreal RAN or DEX implant were evaluated before and at the 1st, 3rd, and 6th months after the injection. Primary outcome measures were the change in best-corrected visual acuity (BCVA) and central retinal thickness. The level of statistical significance was set at 0.05/3=0.016, according to the Bonferroni correction. Thirty-nine eyes of 39 patients were included in the study. The mean age of the study population was 53.82±5.08 years. Median BCVA in the DEX group (n=23) at baseline, 1st, 3rd, and 6th month was 1.1, 0.80 (p=0.002), 0.70 (p=0.003), and 1 (p=0.018) logarithm of the minimum angle of resolution (log-MAR), respectively (p<0.05). Median BCVA in the RAN group (n=16) at baseline, 1st, 3rd, and 6th months was 0.90, 0.61, 0.52, and 0.46 logMAR, respectively (p<0.016 for all comparisons). Median central macular thickness (CMT) in the DEX group at baseline, 1st, 3rd, and 6th months was 515, 260, 248, and 367 μm, respectively (p<0.016 for all comparisons). Median CMT in the RAN group at baseline, 1st, 3rd, and 6th months was 432.5 (p<0.016), 275 (p<0.016), 246 (p<0.016), and 338 (p=0.148) μm. There is no significant difference in treatment efficacies in both visual and anatomical outcomes at the end of the 6th month. However, RAN can be considered the first choice in younger patients with macular edema secondary to branch RVO because of the lower side effect profile.

OPTICAL COHERENCE TOMOGRAPHY FEATURES IN IDIOPATHIC NONINFECTIOUS INTERMEDIATE, POSTERIOR, OR PANUVEITIS.

To characterize optical coherence tomography features in patients with idiopathic intermediate, posterior, or panuveitis. This is a retrospective case series of all consecutive cases of idiopathic intermediate, posterior, or panuveitis at four tertiary care centres between 2010 and 2021. A total of 94 eyes (55 patients) were followed for an average duration of 29.8 (SD 21) months. The median central macular thickness was 284 µ m at baseline and 267 µ m at last follow-up. At baseline and last follow-up, respectively, 24% and 20% of uveitic eyes had intraretinal fluid, 12% and 1% subretinal fluid, and 43% and 54% epiretinal membrane. In addition, ellipsoid zone abnormalities on en-face were noted in 34% and 19% of cases at baseline and last follow-up, respectively. The baseline median visual acuity was significantly lower among cases with ellipsoid zone en-face slab abnormalities compared with those without (0.2 logarithm of minimum angle of resolution [interquartile range: 0-0.6] vs. 0.1 logarithm of minimum angle of resolution [interquartile range: 0-0.3], P = 0.0051). With initiation of treatment, the central macular thickness, intraretinal fluid, subretinal fluid, and ellipsoid zone en-face abnormalities improved over time, whereas the number of cases with epiretinal membrane increased among eyes with idiopathic intermediate, posterior, and panuveitis. Presence of ellipsoid zone en-face abnormalities at presentation may be associated with worse visual acuity.

Macular Morphology in Patients With Diabetic Retinopathy Treated by ILM Peeling: A Propensity Score-Matched Analysis.

To analyze the effects of vitrectomy combined with internal limiting membrane (ILM) peeling in patients with diabetic retinopathy (DR) by propensity score-matched analysis. Patients with proliferative DR that underwent pars plana vitrectomy were divided into two groups: without or with additional ILM peeling. Propensity score-matched analyses of variables were carried out. Optical coherence tomography (OCT) was conducted at the 6-month follow-up. The primary outcome measures were epiretinal membrane (ERM), intraretinal cystic changes, recurrent macular edema, and blurring of the inner segment/outer segment (IS/OS) margin. There were 41 patients in Group 1 (non-ILM peeling) and 41 patients in Group 2 (ILM peeling). ERM was observed in 11 of 41 eyes (26.8%) in Group 1, and three of 41 eyes (7%) in Group 2 at the 6-month follow-up (P = .019). Intraretinal cystoid changes were observed in 13 eyes of Group 1 and four eyes of Group 2 (P = .014). The median central macular thickness was 250.00 ± 135.09 μm in Group 1 and 235.00 ± 101.55 μm in Group 2 (P = .738). Macular edema was observed in 24 eyes (58.5%) in Group 1 and 19 eyes (46.3%) in Group 2 (P = 0.269). There was no significant difference in foveal dip angle between the groups (P = .820). The IS/OS margin was disrupted in 48.8% and 56.1% of eyes in Groups 1 and 2, respectively, without significant difference. There was also no significant difference in best-corrected visual acuity (BCVA) between two groups before surgery, and there was no significant difference in BCVA between two groups at 6 months after surgery (P = .13). The authors' results indicate that vitrectomy combined with ILM peeling can minimize ERM formation and eliminate intraretinal cystoid changes, but the functional recovery is limited. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:420-425.].

May ganglion cell complex analysis be a marker for glaucoma susceptibility in unilateral Fuchs' uveitis syndrome?

To compare retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer thickness (GCIPLT) in the affected eyes to fellow unaffected eyes of patients with unilateral Fuchs' uveitis syndrome (FUS) and analyze their change over time. Twenty seven unilateral FUS patients who did not have concomitant systemic or ocular disease were retrospectively enrolled. Central macular thickness (CMT), RNFL thickness, and GCIPLT measurements were evaluated. Data was analyzed using the non-parametric Brunner-Langer model (LD-F2 design) and Wilcoxon signed-rank test. The mean age of the patients was 40.2 ± 10.2years. The median disease duration was 11 (2-62) months. The median best-corrected visual acuity (BCVA) of the affected eyes and the fellow eyes was 0.22 (0.00-2.50) vs. 0.00 (0.0-0.10) logMAR at the initial visit and 0.05 (0.00-2.50) vs. 0.00 (0.0-0.30) logMAR at the final visit. The change in BCVA was found significant in the affected eyes, but not in the fellow eyes (p < 0.001 and p = 0.287, respectively). The median CMT in the affected eyes at the final visit was not statistically different from the value at the initial visit (255 (157-306) vs. 245 (140-310) µm, p = 0.256). The change in RNFL thickness over time in the affected eyes was similar to the fellow unaffected eyes of the patients with unilateral FUS at all quadrants, with non-significant time and group effects (p > 0.05). However, median GCIPLT in all quadrants (except superonasal) in the affected eyes was statistically lower than the fellow eyes at the initial and final visits (p < 0.05). The most affected quadrant of the ganglion cell complex was inferonasal in the involved eyes (79 (42-97) vs. 75 (43-87) µm) at initial and final visits (p = 0.033 for time effect and p < 0.001 for group effect, respectively). Median CMT and RNFL thickness did not change during follow-up in the affected eyes of patients with unilateral FUS. Median GCIPLT in the affected eyes declined over time in all quadrants. Ganglion cell loss was also most prominent in the inferonasal quadrant in the affected eyes. FUS patients should be followed up long-term in terms of ganglion cell loss, especially in the inferonasal quadrant.

Effects of the COVID-19 pandemic on neovascular age-related macular degeneration and response to delayed Anti-VEGF treatment

ObjectivesTo investigate the effects of the COVID-19 pandemic on the treatment course of neovascular age-related macular degeneration (nAMD) patients who received anti-VEGF injection therapy with real-life data.MethodsThis retrospective study consisted of 116 eyes of 106 patients. Ophthalmic examination, assessment of best-corrected visual acuity (BCVA), optical coherence tomography (OCT) findings and data of last two visits before restrictions (V-2 and V-1) and the first visit (V0) after the release of national lockdown and subsequent visits (V1 and Vlast) were recorded. The lockdown period was determined by the time interval between March 11 and June 1, 2020.Main resultsThe injection interval before V-1 was significantly longer than the interval after V0 (2.56 ± 0.9 vs. 2.14 ± 0.8 months, P = 0.02). While the median central macular thickness (CMT) was significantly increased at V0 compared to V-1 [274(132–711) vs. 238(136–628), P < 0.001], the median CMT was significantly lower at V1 compared to V0 [256 (136–591) vs. 274(132–711), P = 0.003]. The median BCVA was 0.67(0.1–1.1) logMAR at V-1 and significantly worsened to 0.78 (0.1–1.2) logMAR at V0 (P = 0.003). Although the median BCVA improved to 0.69 logMAR (0.1–1.2) at Vlast, the difference did not reach statistical significance compared to V0 (P = 0.08).ConclusionTreatment delay due to the COVID-19 pandemic cause progression of nAMD and visual impairment. To plan more frequent anti-VEGF treatments and visits may be an appropriate approach until the disease stabilizes. However, it should be kept in mind that despite the improvement in OCT findings, the desired success in VA could not be achieved in the short term.

Intravitreal Bevacizumab for Macular Edema Secondary to Retinal Vein Occlusion.

The most common cause of vision loss in cases of Retinal vein occlusion (RVO) is due to macular edema. This study was conducted to examine the effect of intravitreal bevacizumab (IVB) in the treatment of macular edema secondary to RVO. The authors conducted a retrospective study of 94 eyes (N) of 92 patients with macular edema associated with decreased visual acuity secondary to RVO who were treated with IVB. Patients received IVB at baseline, 1 month and 2 months. At each follow up patients were evaluated and re-injected if necessary. The mean age of the patients was 56.6 ±11.51 years. The average number of injections per eye was 2.1 ± 0.87. The baseline median central macular thickness (CMT) and best-corrected visual acuity (BCVA) in LogMAR was 465.00μm (Min 254μm, Max 1218μm) and 1.00 (Min 0.30, Max 2.28), respectively. The median CMT at one month following first, second and third dose of IVB was 258μm (N=94, Z= -7.64, p <0.001), 261μm (N=63, Z= -0.17, p=0.86), and 292μm (N=41, Z= -0.21, p= 0.83), respectively. The median LogMAR BCVA at one month following first, second and third dose of IVB was 0.60 (N=94, Z= -5.70, p < 0.001), 0.60 (N=63, Z= -1.69, p=0.09), and 0.60 (N=41, Z= -0.03, p=0.97), respectively. Pre-operative BCVA was the best predictor of the final visual outcome after IVB in cases of RVO. None of the patients developed any serious ocular or systemic complications due to IVB. IVB is an effective and safe treatment for macular edema associated with decreased visual acuity secondary to RVO. The most beneficial effect of IVB is seen at one month after the first dose. The efficacy of subsequent doses could not be established in this study.

Efficacy of the subthreshold micropulse yellow wavelength laser photostimulation in the treatment of chronic central serous chorioretinopathy

To evaluate the efficacy and safety of subthreshold micropulse yellow laser (SMYL) in the treatment of chronic central serous chorioretinopathy (CCSC). The medical records of 58 eyes of 58 patients with CCSC were reviewed. A 577-nm SMYL system was used for the treatment. Fundus fluorescein angiography was used as the primary method of identifying CCSC, and resolution of subretinal fluid (SRF) evaluated by optical coherence tomography (OCT) and fundus autofluorescence. Central macular thickness (CMT), central macular volume (CMV), total macular volume (TMV), subfoveal choroidal thickness (SFCT), subretinal fluid height (SRFH), and subfoveal fluid basement diameter values were measured by spectral domain-OCT (SD-OCT) for all eyes. The mean age of the patients was 42.4±9.9 (range: 20-72)y. The mean follow-up was 11.4±8.5 (range: 6-37)mo. Median BCVA at at the final follow up after treatment was statistically significant from the baseline. Complete SRF resolution was 12.1% of the eyes in the 1st month, 67.2% of the eyes in the 3rd month and 67.2% of the eyes in the last follow up. The initial median CMT, CMV, TMV, and SFCT values before treatment was significantly higher than 3rd month visit values (P<0.001). In the multivariate analysis performed, age and disease duration were found to be a risk factor for persistent SRF (P=0.017, P=0.016, respectively). SMYL treatment provides a significant anatomical and functional improvement and is effective in eliminating SRF in eyes with CCSC.

One-year outcomes of half-fluence photodynamic therapy combined with intravitreal injection of aflibercept for pachychoroid neovasculopathy without polypoidal lesions.

To evaluate the 1-year efficacy of half-fluence photodynamic therapy (HFPDT) combined with intravitreal aflibercept injection on treatment-naïve pachychoroid neovasculopathy (PNV) without polypoidal lesions. Retrospective, interventional case series PATIENTS AND METHODS: We retrospectively studied 21 eyes with treatment-naïve PNV and assessed the best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), pachyvessel vertical diameter, and choroidal neovascularization thickness (CNVT) at the fovea over a 12-month period. The median BCVA was 0.15 at baseline, 0.00 (P < .05) at 3 months, 0.05 at 6 months, and -0.08 (P < .05) at 12 months. The BCVA was significantly improved at 3 months and 12 months as compared with the baseline BCVA. The median CMT was 230 μm at baseline, 140 μm (P < .01) at 3 months, 150 μm (P < .01) at 6 months, and 150 μm (P < .01) at 12 months. The median CCT was 386 μm at baseline, 347 μm (P < .01) at 3 months, 331 μm (P < .01) at 6 months, and 352 μm (P < .01) at 12 months. The median pachyvessel vertical diameter was 309 μm at baseline, 246 μm (P < .01) at 3 months, 232 μm (P < .01) at 6 months, and 242 μm (P < .01) at 12 months. The median CNVT was 28 μm at baseline, 17 μm (P < .01) at 3 months, 19 μm (P < .05) at 6 months, and 21 μm (P < .05) at 12 months. The CMT, CCT, pachyvessel vertical diameter, and CNVT were significantly decreased at 3, 6, and 12 months as compared with those at baseline. Whilst 17 eyes (81.0%) showed no signs of CNV recurrence during the 12-month period, 4 eyes (19.0%) required additional combination therapy. HFPDT combined with intravitreal aflibercept injection may effectively improve BCVA and ameliorate exudative changes in eyes with PNV without polypoidal lesions for up to 1 year.

Short-term outcomes of combined pars plana vitrectomy for epiretinal membrane and phacoemulsification surgery with multifocal intraocular lens implantation.

PurposeThe purpose of this study was to evaluate the functional and anatomical outcomes of combined phacovitrectomy with multifocal intraocular lens (mfIOL) implantation.MethodsRetrospective, interventional, non-comparative case series of six eyes that received a combined phacoemulsification surgery with apodized, diffractive mfIOL implantation for cataract and pars plana vitrectomy (PPV) with membrane peeling for epiretinal membrane (ERM). Outcome measures included distance and near visual acuities (DVA and NVA), central macular thickness (CMT), intraocular pressure (IOP), and disruption of external limiting membrane (ELM) or inner-segment outer-segment (IS/OS) junction.ResultsMean logMAR glare DVA improved from 0.40 (Snellen 20/50) preoperatively to a mean uncorrected DVA of 0.038 (Snellen 20/22) (P=0.004) at 6 months after surgery. All eyes achieved NVA of J2 or better by 12 months postoperatively. Median CMT improved by 10 µm and mean IOP increased by 1 mmHg at 12 months postoperatively. Percentage of patients with ELM or IS/OS disruptions decreased from 66.7% to 33.3%. Two eyes demonstrated residual metamorphopsia on Amsler grid testing postoperatively. Postoperatively, four eyes required laser capsulotomy and one required LASEK for refractive correction.ConclusionCombined phacovitrectomy, membrane peeling, and mfIOL implantation improved VA in patients with idiopathic ERM. Multifocality was achieved, but final visual outcome was delayed due to posterior capsular opacification and macular healing.

Treatment of refractory diabetic macular edema with a fluocinolone acetonide implant in vitrectomized and non-vitrectomized eyes.

To report real-life data on the use of an intravitreal fluocinolone acetonide implant in the treatment of refractory diabetic macular edema (DME) in pars plana vitrectomized (PPV) and non-PPV eyes. This was a comparative retrospective observational study of 23 eyes with chronic DME. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded at baseline, 1, 4 and 12mo. Descriptive statistics and non-parametric tests were performed to analyze and compare PPV and non-PPV eyes. Seven PPV and 16 non-PPV eyes were included in the study. Median BCVA in the non-PPV group varied from 0.65 logMAR [Interquartile range (IQR): 0.40] at baseline to 0.42 logMAR (IQR: 0.40) at 12mo. Median CMT varied from 430 µm (IQR: 131.3) at baseline to 317 µm (IQR: 107.5) at 12mo. Median BCVA in the PPV group varied from 0.60 logMAR (IQR: 0.62) at baseline to 0.74 logMAR (IQR: 0.34) at 12mo. Median CMT varied from 483 µm (IQR: 146) at baseline to 397 µm (IQR: 132) at 12mo. Of 0/7 eyes and 1/16 eyes in the PPV and non-PPV eyes respectively had a baseline visual acuity of 6/12 or better (0.3 logMAR). At last follow up, 1/7 and 5/16 eyes in the PPV and non-PPV group respectively achieved a visual acuity of 6/12 or better. Visual outcomes are modest following the use of the fluocinolone acetonide implant for chronic DME. The steroid implant is a useful treatment option in the management of refractory DME in vitrectomized and non-vitrectmized eyes.

Intravitreal aflibercept therapy in eyes with chronic central serous chorioretihopathy: Short term results

Abstract Objectives To evaluate the short term efficacy and tolerability results of intravitreal aflibercept injection as a treatment option for eyes with chronic central serous chorioretinopathy (CSCR). Materials and methods A prospective longitudinal study. Ten eyes of 10 patients with chronic CSCR who had been followed for >6 months after the first intravitreal injection of aflibercept were recruited for the study. The best corrected visual acuity (BCVA) and central macular thickness (CMT) values obtained by spectral-domain optical coherence tomography were recorded at baseline and the first, third, and sixth months after the injection. Results The mean logMAR BCVA was 0.70 ± 0.25 at baseline. At the first, third, and sixth months after the injection, the mean logMAR BCVA were 0.39 ± 0.36, 0.32 ± 0.39, and 0.29 ± 0.34, respectively. The mean and median BCVA over the entire follow-up period was significantly improved compared with baseline BCVA (p The mean CMT was 449.30 ± 142.53 μm at baseline. It was measured as 302.60 ± 72.28 μm on the first month, 294.30 ± 72.85 μm on the third month, and 294.60 ± 83.84 μm on the sixth month after the injection. The mean and median CMT during the entire follow-up period was significantly decreased compared with baseline CMT (p Conclusions Short-term results of this study demonstrate that intravitreal aflibercept may be used as a treatment option to improve the BCVA and reduce the CMT in chronic CSCR.

Terapia intravítrea con aflibercept en ojos con coriorretinopatía serosa central crónica: resultados a corto plazo

ObjectivesTo evaluate the short term efficacy and tolerability results of intravitreal aflibercept injection as a treatment option for eyes with chronic central serous chorioretinopathy (CSCR). Material and methodsA prospective longitudinal study. Ten eyes of 10 patients with chronic CSCR who had been followed for >6months after the first intravitreal injection of aflibercept were recruited for the study. The best corrected visual acuity (BCVA) and central macular thickness (CMT) values obtained by spectral-domain optical coherence tomography were recorded at baseline and the first, third, and sixth months after the injection. ResultsThe mean logMAR BCVA was 0.70±0.25 at baseline. At the first, third, and sixth months after the injection, the mean logMAR BCVA were 0.39±0.36, 0.32±0.39, and 0.29±0.34, respectively. The mean and median BCVA over the entire follow-up period was significantly improved compared with baseline BCVA (P<.05 for each one).The mean CMT was 449.30±142.53μm at baseline. It was measured as 302.60±72.28μm on the first month, 294.30±72.85μm on the third month, and 294.60±83.84μm on the sixth month after the injection. The mean and median CMT during the entire follow-up period was significantly decreased compared with baseline CMT (P<.05 for each one). None of the patients had any serious ocular or systemic side effects over the course of the study. ConclusionsShort term results of this study demonstrate that intravitreal aflibercept may be used as a treatment option to improve the BCVA and reduce the CMT in chronic CSCR.

Visual acuity loss associated with excessive "dry macula" in exudative age-related macular degeneration.

PurposeTo investigate the correlation between visual acuity and central macular thickness (CMT) and choroidal thickness (CCT) in patients with wet age-related macular degeneration (AMD).MethodsIn this retrospective analysis, 14 eyes that received >10 ranibizumab injections (based on pro re nata [PRN] regimen) and maintained initial visual acuity gain were analyzed. The following 5 parameters were measured at the foveal center: CMT (distance from the inner limiting membrane [ILM] to Bruch’s membrane); central retinal thickness (CRT; distance from the ILM to the inner limit of the retinal pigment epithelium or subretinal fluid [SRF]); SRF thickness (SRFT); pigment epithelium detachment thickness (PEDT); and CCT. The correlation between the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) and the 5 parameters was examined with generalized estimating equations.ResultsCMT, CRT, and CCT were negatively correlated with logMAR BCVA (P=0.031, 0.023, and 0.036, respectively) when only CMT values less than the thickness that maximized visual acuity for each eye were used for the analysis. Each 100-μm reduction in CMT, CRT, or CCT improved logMAR BCVA by −0.1, −0.08, or −0.07, respectively. SRFT and PEDT were not correlated with BCVA. The median CMT that maximized the visual acuity was 230 μm.ConclusionDry macula with CMT <230 μm was associated with temporary decrease in visual acuity in AMD patients whose visual acuity was maintained with PRN regimen.

Visual outcomes and anatomic changes after sub-threshold micropulse yellow laser (577-nm) treatment for chronic central serous chorioretinopathy: long-term follow-up.

PurposeTo analyze the long-term efficacy of 577 nm sub-threshold micropulse yellow laser (SMYL) in the treatment of chronic central serous chorioretinopathy (CCSC) and to evaluate the anatomic outcome, visual results and safety profile of the treatment.Patients and methodsThis prospective study assessed 39 eyes of 39 patients with non-resolving CCSC lasting more than three months. All eyes were treated by using 577 nm SMYL system with 5% duty cycle (DC) and each patients was monitored monthly. The main outcome measures were best-corrected visual acuity (BCVA), contrast sensitivity (CS) and subretinal fluid (SRF) height, central macular thickness (CMT), central macular volume (CMV), total macular volume (TMV), and subfoveal choroidal thickness (SFCT) measured by spectral domain optical coherence tomography (SD-OCT).ResultsThe median follow-up time period was 17.82±0.42 (13-23 months) months. The BCVA was improved significantly at final follow-up in comparison of baseline visit (P<0.01) in 35 eyes (89.7%) and in 4 eyes (10.3%) was stable. The median CMT, CMV, TMV before treatment was 369 μm, 0.30 mm3, and 9.86 mm3, in comparison to 250 μm, 0.19 mm3, and 8.76 mm3 at final follow-up, respectively (P<0.01 for all these parameters). Initial median SFCT was recorded as 364 μm and 342 μm at the final follow-up (P<0.001).DiscussionResults suggest that SMYL treatment is an effective method as response was rapid and procedure is safe to manage the non-resolving CCSC eyes.

Cost‐effectiveness of intravitreal therapy with both anti‐VEGF and Dexamethasone implant in patients with Diabetic Macular Edema

PurposeThe aim of this study was to evaluate the cost‐effectiveness of intravitreal therapy (IVT) with both anti‐VEGF and Dexamethasone implant in patients with Diabetic Macular Edema (DME) during two years’ follow‐up.MethodsA retrospective review of 191 patients (382 eyes) with type I and II diabetes and DME was performed. Pre‐IVT and final best correct visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), number and type of IVT,number of examinations, and fluorescein angiography were assessed. Based on surgery procedure other than IVT, patients were divided into 5 groups. To avoid bias, we analysed only patients who had undergone cataract surgery before (group 1) or during enrolment (group 2).Results41 eyes from Group 1 and 48 eyes from group 2 were evaluated. Median BCVA ranged between 20/80 and 20/63 Snellen (P = 0.008) in Group 1 and from 20/63 to 20/40 Snellen (P = 0.0035) in Group 2, while improvement up to 1 Snellen line was observed in 58.5 and 68.75% of eyes in Group 1 and 2, respectively.In terms of median CMT, a statistically reduction (P = 0.0007) was found in Group 2 (‐85 μm), whereas no statistical differences were found in Group 1. The two groups showed no statistically significant difference in median IOP. The estimated cost per eye was €7803 in Group 1 and €8988 Group 2, whereas the mean cost per patient was €15190 and €16580 in Group 1 and 2, respectively. Analysis between groups did not show any statistical difference in the considered parameters.ConclusionsIn this study, despite the high treatment cost, vision improvement in DME patients undergoing IVT was disappointing. Our results emphasise the need for a better understanding of the cost‐effectiveness of DME treatment