Panretinal Photocoagulation Research Articles

A Study of the Demographic Profile, Screening, and Management of Patients Visiting a Retinopathy of Prematurity Clinic.

Background and objective Retinopathy of prematurity (ROP) is a retinal vasoproliferative disease affecting premature infants. Despite improvements in neonatal care and management, ROP still remains a major cause of childhood blindness worldwide. Studying the demographic profile and screening is essential to develop predictive models, to gain insights into the cause of retinal vascular diseases and diseases of prematurity, and to determine the future management and research in ROP. The objective of the present study was to estimate the incidence of ROP, to identify the risk factors that predispose to ROP, and to assess the outcome of these cases. Hence, this study was conducted in a tertiary care hospital in Maharashtra. Method A prospective, observational study was conducted from 10 August 2022 to 10 October 2022.Infants withgestational ages < 34 weeks, birth weights< 2000 g, infants who received supplemental oxygen therapy, or patients who required NICU stay were screenedfor ROP. Demographic details were recorded to assess the risk factors and treatment was given according to the severity of ROP grade. Result A total of 160 eyes of80 infants were screened and analysed. The overall incidence of "any ROP" was19 patients (38 eyes), i.e., 24%. Out of 80 patients, six were of 28 weeks gestational age, of whomfour (67%) were positive for ROP. The mean birth weight of infants with ROP was 1331.58 ± 238.532 g (p < 0.0001). ROP stage 1 was seen in five patients (26.32%), stage 2 in 10 patients (52.63%), and stage 3 in four patients (21.0%), with no subjects in stages 4 & 5. Out of 19 patients, six (32%) had type 1 ROP, and 13 (68%) had type 2 ROP.Out of 19cases, 13 (68%) received follow-upcare based on the severity of their disease, and six (32%) were treated with panretinal photocoagulation (PRP) laser. Conclusion Incidence of any ROP was 24%. Prematurity, low birth weight, and oxygen therapy remain the most significant risk factors associated with the development of ROP. Early referral, diagnosis, and timely intervention will play a monumental role in improving the prognosis of this potentially blinding disease.

Peripheral PRP in the Operating Room vs Standard Clinic PRP for the Initial Treatment of PDR.

Purpose: To compare the long-term outcomes of standard panretinal photocoagulation (PRP) performed in the operating room (OR) with peripheral PRP performed in the clinic in treatment-naïve patients with proliferative diabetic retinopathy (PDR). Methods: Consecutive cases from 2017 to 2022 were retrospectively reviewed. Exclusion criteria included previous PRP, pars plana vitrectomy performed at the time of the initial PRP, PRP performed in another setting within 3 months of the initial treatment, a documented plan for future PRP at the time of the initial treatment, and less than 3 years of follow-up. Negative binomial regressions were used to compare the number of subsequent interventions between the 2 groups and t tests to compare the visual acuity (VA) outcomes. Results: Of the 961 eyes of 679 patients screened, 82 eyes of 53 patients met the inclusion criteria. The initial PRP was performed in the OR (OR cohort) in 57 eyes of 38 patients and in the clinic (clinic cohort) in 25 eyes of 15 patients. The OR cohort had a mean of 0.4 subsequent surgeries and 0.8 subsequent PRP treatments and the clinic cohort, 0.8 subsequent surgeries (P < .05) and 1.8 subsequent PRP treatments (P < .05). No significant between-group difference was found in the VA outcomes over the long-term follow-up (mean, 44.2 months). Conclusions: Peripheral PRP performed in the OR resulted in fewer subsequent interventions than standard PRP in the clinic and may afford better control of PDR.

Loss to Follow up in Patients with Proliferative Diabetic Retinopathy Treated with Anti-VEGF Therapy and/or Panretinal Photocoagulation in the United States

PurposeTo determine the rate of loss to follow up (LTFU) in patients with proliferative diabetic retinopathy (PDR) treated with anti-VEGF therapy and/or PRP in the United States. DesignRetrospective cohort study using the national IRIS® Registry (Intelligent Research in Sight) data. Subjects73,595 eyes of 56,590 patients with PDR diagnosed between 2013-2015 and treated between 2013-2018. MethodsMultivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Main Outcome MeasuresLTFU was no follow up within 12 months from last treatment. ResultsFor patient eyes treated for PDR, 11.7% (95% CI, 11.5-12.0) were LTFU. Among PDR patients treated with anti-VEGF therapy alone, PRP alone, and anti-VEGF and PRP, the rates of LTFU were 12.3% (95% CI: 11.8-12.7), 12.6% (95% CI, 12.1-13.0) and 10.8% (95% CI, 10.4-11.1) respectively. Risk factors for LTFU include Black or African American race/ethnicity (OR 1.26; 95% CI, 1.13-1.41; p<0.001), Hispanic ethnicity (OR 1.28; 95% CI, 1.16-1.42; p<0.001), Native American/Alaska Native or Native Hawaiian/Other Pacific Islander race/ethnicity (OR, 2.69; 95% CI, 2.14-3.38; p<0.001), and unilateral disease (OR 2.05; CI, 1.88-2.23; p<0.001). Odds for LTFU were higher with patients with baseline vision of 20/50-20/200 (OR, 1.25; 95% CI, 1.15-1.36; p<0.001) and with vision worse than 20/200 (OR, 1.22; 95% CI, 1.05-1.42; p=0.01) than for patient eyes with a baseline visual acuity of 20/40 or better. Odds for LTFU were lower for Medicare Fee For Service (OR, 0.71; 95% CI, 0.64-0.79; p<0.001) and Medicare Managed (OR, 0.66; 95% CI, 0.56-0.78; p<0.001) compared to Private insurance. Odds for LTFU were lower for patients treated in the Midwest (OR, 0.72; 95% CI, 0.64-0.81; p<0.001) and West (OR, 0.83; 95% CI, 0.74-0.94; p=0.003) compared to in the South region. ConclusionsThe rate of LTFU is between 10-12% among patients with PDR who were treated with anti-VEGF injections and/or PRP. Risk factors include Black or African American race/ethnicity, Hispanic ethnicity, baseline vision worse than 20/40, private insurance, South region and unilateral disease.

Anti–Vascular Endothelial Growth Factor Drugs Compared With Panretinal Photocoagulation for the Treatment of Proliferative Diabetic Retinopathy: A Cost-Effectiveness Analysis

ObjectivesThis study aimed to evaluate the cost-effectiveness of anti–vascular endothelial growth factor drugs (anti-VEGFs) compared with panretinal photocoagulation (PRP) for treating proliferative diabetic retinopathy (PDR) in the United Kingdom. MethodsA discrete event simulation model was developed, informed by individual participant data meta-analysis. The model captures treatment effects on best corrected visual acuity in both eyes, and the occurrence of diabetic macular edema and vitreous hemorrhage. The model also estimates the value of undertaking further research to resolve decision uncertainty. ResultsAnti-VEGFs are unlikely to generate clinically meaningful benefits over PRP. The model predicted anti-VEGFs be more costly and similarly effective as PRP, generating 0.029 fewer quality-adjusted life-years at an additional cost of £3688, with a net health benefit of −0.214 at a £20 000 willingness-to-pay threshold. Scenario analysis results suggest that only under very select conditions may anti-VEGFs offer potential for cost-effective treatment of PDR. The consequences of loss to follow-up were an important driver of model outcomes. ConclusionsAnti-VEGFs are unlikely to be a cost-effective treatment for early PDR compared with PRP. Anti-VEGFs are generally associated with higher costs and similar health outcomes across various scenarios. Although anti-VEGFs were associated with lower diabetic macular edema rates, the number of cases avoided is insufficient to offset the additional treatment costs. Key uncertainties relate to the long-term comparative effectiveness of anti-VEGFs, particularly considering the real-world rates and consequences of treatment nonadherence. Further research on long-term visual acuity and rates of vision-threatening complications may be beneficial in resolving uncertainties.

An Eye for A Foot: Alarming Unawareness of Diabetic Retinopathy Among Diabetic Foot Patients.

This study aims to determine the awareness of diabetic retinopathy in patients hospitalized for diabetic foot ulcers, examine their clinical and demographic characteristics, and evaluate their treatment needs. In this prospective study, 62 consequent patients with diabetic foot ulcers who were hospitalized for further treatment in Diabetic Foot Department between June and August 2023 were subjected to ophthalmological examinations. Detailed anterior and posterior segment examinations were performed. Clinical and demographic characteristics and HbA1c levels were recorded. Thirty-nine patients (62.9%) were male and 23 (37.1%) were female. The mean age was 61 ± 11.4 years. The patients had diabetes mellitus (DM) for an average of 19.2 ± 9.6 years. The average HbA1c value of the patients was 9 ± 2.3%. Minor amputation was performed in 35 of 62 patients (56.5%) during treatment. Thirty-one patients (50%) were unaware of the risk of diabetic retinopathy. Of those "unaware" 31 patients, 26 (83.9%) had diabetic retinopathy. Diabetic retinopathy was detected in 57 patients (91.9%) and 3-month interval ophthalmological follow-up screening was recommended for 77 eyes. Eighty percent of the patients never had ophthalmological examination. Intravitreal (IV) injection was performed in 44 eyes, panretinal photocoagulation (PRP) in 2 eyes, and intravenous injection + PRP + vitreoretinal surgery in one eye. Diabetic foot ulcers and diabetic retinopathy are often accompanied by each other. Patients should be informed about this and strongly encouraged to undergo routine ophthalmological examinations, especially when they have advanced diabetic foot disease. Diabetic foot surgeons should keep in mind that a poor eye cannot detect diabetic foot problems.

Acute Retinal Necrosis Complicated by Serous Retinal Detachment Associated with Varicella-Zoster Virus Infection in an Immunocompetent Young Adult

Acute retinal necrosis syndrome (ARN syndrome) is a rare, rapidly progressive viral retinitis with a grim functional prognosis. We present a case of a 43-year-old immunocompetent woman who experienced unilateral acute retinal necrosis, with Varicella-Zoster Virus (VZV) infection as the etiology. A unilateral vesicular facial rash accompanied by rapidly declining visual acuity over 7 days prompted consultation. Intravenous antiviral treatment and panretinal photocoagulation laser (PPR) were initiated, followed by antiviral prophylaxis. The patient developed ophthalmic zona lesions, peripheral retinal ischemia, and unilateral macular serous retinal detachment (SRD). Treatment included valacyclovir, corticotherapy and PPR laser. Knowledge of this condition, diagnosed clinically, is crucial due to its rapid progression and severe complications. Early intervention appears to be a significant prognostic factor, emphasizing its therapeutic urgency.

Associations between lipid abnormalities and diabetic retinopathy across a large United States national database.

While dyslipidaemia has been suggested as a potential risk factor for diabetic retinopathy (DR), previous studies have reported conflicting findings. This study aimed to better characterize the relationship between abnormal serum levels of various lipid markers and the risk of the development and progression of DR. This retrospective cohort study utilized a United States national database of electronic medical records. Adults with a history of type 2 diabetes mellitus without type 1 diabetes mellitus were divided into cohorts based on the presence of abnormal serum levels of various lipid markers. Propensity score matching was performed to match cohorts with abnormal lipid levels to those with normal lipid levels on covariates. The cohorts were then compared to evaluate the hazard ratios (HR) of receiving a new DR diagnosis, pars plana vitrectomy, panretinal photocoagulation, vitreous haemorrhage, proliferative diabetic retinopathy, diabetic macular oedema (DMO), and traction retinal detachment. The database contained 1,126,231 eligible patients (mean age: 60.8 [14.2] years; 46.0% female). Among patients without prior DR, low HDL (HR = 0.94, CI = 0.90-0.98), total cholesterol (HR = 0.88, CI = 0.85-0.91), and high triglyceride (HR = 0.91, CI = 0.86-0.97) levels were associated with a decreased risk of receiving a DR diagnosis. Among patients with preexisting DR, high LDL levels was associated with an increased risk of DMO (HR = 1.42, CI = 1.15-1.75), whereas low HDL levels was associated with a marginally decreased risk (HR = 0.92, CI = 0.85-0.99). Elevated levels of markers of dyslipidaemia are inversely associated with the risk of receiving a DR diagnosis, but this relationship is blunted after the onset of DR.

A Case Report on IRVAN Syndrome

Idiopathic retinal vasculitis, arteriolar macroaneurysms, and neuroretinitis (IRVAN) is a rare condition predominantly affecting young, healthy females without systemic disease. We present the case of a 35-year-old female who presented with a 3-month history of decreased visual acuity without associated symptoms. Ophthalmological examination revealed reduced visual acuity in both eyes, papillary oedema, stellate macular oedema, and haemorrhages bilaterally. Retinal imaging confirmed IRVAN syndrome. Treatment included pan-retinal photocoagulation (PRP) and intravitreal bevacizumab injections, resulting in macular oedema regression.

Комбинированный метод лечения рефрактерного диабетического макулярного отека

Purpose. To determine the effectiveness of the anatomical and functional results of treatment of refractory diabetic macular edema after removal of the inner limiting membrane using the latest generation anti-VEGF drug. Material and methods. We examined 6 patients with 1st type and 2nd type diabetes mellitus. The average age of the subjects was 47.45 ± 27.15 years. Of these, there were 4 women and 2 men. 1st type diabetes mellitus was detected in 2 people, in other patients — 2nd type. 3 patients had previously undergone pan-retinal photocoagulation (from 1st to 2nd stages). All patients received intravitreal injections (anti-VEGF) of Eylea (4–5 injections) during the last year. According to the optical coherence tomogram (OCT), macular edema was recorded, recurring on average after 1.36 ± 0.85 months. All patients underwent surgical treatment. In the presence of lens opacity, surgical treatment was started with phacoemulsification of cataracts. A microinvasive subtotal vitrectomy was performed with the removal of the posterior layers of the vitreous body and proliferative membranes fixed to the retina. The removal of the inner boundary membrane was performed after its staining in the size of two to three diameters of the optic disc without any tamponade. After 2 months, two patients had an increase in retinal thickness in the fovea. These patients received one injection of Vabismo. Results. The compared groups did not differ in morphofunctional characteristics. In the postoperative period, there was a tendency to increase visual acuity and decrease retinal thickness, regression of hard exudates in 4 patients. In 2 patients, an increase in retinal thickness in the fovea was noted after 2 months. After intravitreal injection of the latest generation anti-VEGF drug (Vabismo), these patients also showed an increase in visual acuity, regression of solid exudates and a decrease in retinal thickness. Conclusion. Microinvasive subtotal vitrectomy with removal of the inner limiting membrane in combination with intravitreal injection of the latest generation anti-VEGF drug (Vabismo) is an effective method of treating refractory diabetic macular edema. Keywords: anti-VEGF, Vabismo, diabetic macular edema, intravitreal injections, optical coherence tomogram, subtotal vitrectomy, inner boundary membrane

Comparative efficacy and safety of different anti-VEGF agents combined with different delivery methods for neovascular glaucoma: a systematic review and Bayesian network meta-analysis

ObjectiveTo compare the efficacy and safety of different anti-vascular endothelial growth factor (VEGF) agents combined with different delivery methods for neovascular glaucoma (NVG).DesignSystematic review and Bayesian network meta-analysis (NMA).Data sourcesPubMed,...

Chorioretinal Anastomosis and Retinal Detachment with Laser Photocoagulation Treated Incontinentia Pigmenti.

To describe a case of incontinentia pigmenti in which chorioretinal anastomosis occurred after laser photocoagulation, which was ultimately complicated by tractional and rhegmatogenous detachment. Observational case report. A 2-month-old was referred to ophthalmology for a rash characteristic of incontinentia pigmenti due to concern for ocular involvement and was found to have peripheral avascular retina with early neovascularization. Following several rounds of panretinal photocoagulation, a chorioretinal anastomosis was noted on follow up fluorescein angiography in the left eye. Subsequently, a tractional retinal detachment formed and was treated initially with a lens sparing pars plana vitrectomy, endolaser, and scleral buckle. Despite treatment, it progressed to a combined tractional/rhegmatogenous detachment and was deemed inoperable. Chorioretinal anastomosis is a rare complication of laser photocoagulation.

An Epigenome-Wide Association Study of DNA Methylation and Proliferative Retinopathy over 28 Years in Type 1 Diabetes

To perform a prospective epigenome-wide association study of DNA methylation (DNAm) and 28-year proliferative diabetic retinopathy (PDR) incidence in type 1 diabetes (T1D). Prospective observational cohort study. The Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset (< 17 years) T1D. Stereoscopic fundus photographs were taken in fields 1, 2, and 4 at baseline, 2, 4, 6, 8, 16, 23, and 28 years after DNAm measurements. The photos were graded using the modified Airlie House System. In those free of PDR at baseline (n=265; mean T1D duration of 18 years at baseline), whole blood DNAm (EPIC array) at 683 597 CpGs was analyzed in Cox models for time to event. Associations between significant CpGs and clinical risk factors were assessed; genetic variants associated with DNAm were identified (methylation quantitative trait loci [meQTLs]). Mendelian randomization was used to examine evidence of causal associations between DNAm and PDR. Post hoc regional and functional analyses were performed. Proliferative diabetic retinopathy was defined as the first instance of a grade of ≥ 60 in at least 1 eye or pan-retinal photocoagulation for PDR. Follow-up time was calculated from the study visit at which DNAm data were available (baseline) until PDR incidence or censoring (December 31, 2018 or last follow-up). PDR incidence was 53% over 28-years' follow-up. Greater DNAm of cg27512687 (KIF16B) was associated with reduced PDR incidence (P=6.3×10-9; false discovery rate [FDR]: < 0.01); 113 cis-meQTLs (P<5×10-8) were identified. Mendelianrandomization analysis using the sentinel meQTL as the instrumental variable supported a potentially causal association between cg27512687 and PDR. Cg27512687 was also associated with lower pulse rate and albumin excretion rate and higher estimated glomerular filtration rate, but its association with PDR remained independently significant after adjustment for those factors. In regional analyses, DNAm of FUT4, FKBP1A, and RIN2 was also associated with PDR incidence. DNA methylation of KIF16B, FUT4, FKBP1A, and RIN2 was associated with PDR incidence, supporting roles for epigenetic regulation of iron clearance, developmental pathways, and autophagy in PDR pathogenesis. Further study of those loci may provide insight into novel targets for interventions to prevent or delay PDR in T1D. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Outcomes of intravitreal anti-VEGF injections and panretinal photocoagulation in preretinal hemorrhage secondary to proliferative diabetic retinopathy involving the fovea.

To evaluate the outcome of intravitreal anti-vascular endothelial growth factor (VEGF) injections and panretinal photocoagulation (PRP) in fovea involving preretinal hemorrhage (PRH) secondary to proliferative diabetic retinopathy (PDR). Retrospective non-comparative cross-sectional series of patients diagnosed with fovea involving PRH secondary to PDR at our institute from March 2019 to October 2021 who were treated with combination treatments of intravitreal anti-VEGF and PRP and have completed a minimum 6-month follow-up. The primary outcome measure was serial changes in the visual acuity (VA) and PRH regression from the fovea. Secondary outcome measures were the quantitative assessment of the size of PRH, its association with VA improvement and time to regression, and the proportion of patients who underwent surgery for poor response. In total, 22 eyes of 21 patients showed regression of PRH from the foveal center at 33.6 days, and complete regression was seen at 140.7 days. The average number of anti-VEGF injections required for clearance of PRH from the fovea was 1.6. Mean LogMAR visual acuity improved from 0.54 at baseline to 0.32 at 4 weeks and 0.18 at 6 months ( P < 0.01). Three eyes (13.6%) required vitrectomy surgery during follow-up. The mean area of PRH as measured by Image J analysis was 14.78 mm 2 at baseline, 8.97 mm 2 at 4 weeks, and 1.25 mm 2 at 3 months ( P < 0.01). No statistically significant difference was seen between the size of PRH and PRH clearance time and VA improvement. No systemic side effects were observed following the intravitreal injections during follow-up. Intravitreal anti-VEGF injections and PRP were found to be effective and safe treatment methods for fovea involving PRH secondary to PDR. Long-term studies are warranted to assess the long-term efficacy.

Insights Into Visual Rehabilitation: Pan-Retinal Photocoagulation for Proliferative Diabetic Retinopathy.

This review comprehensively explores pan-retinal photocoagulation (PRP) as a pivotal intervention in visually rehabilitating individuals afflicted with proliferative diabetic retinopathy (PDR). The review begins by elucidating the significance of PDR within the spectrum of diabetic retinopathy (DR), emphasizing the progressive nature of the disease and the consequential impact on visual health. A detailed analysis of PRP follows, encompassing its definition, purpose, and historical development, shedding light on the procedural intricacies and mechanisms of action. The postoperative care and follow-up section underscores the necessity of vigilant monitoring for complications, visual recovery, and the importance of regular ophthalmic check-ups. The subsequent discussion delves into patient education and counseling, stressing the need to manage expectations, encourage lifestyle modifications, and highlight the significance of follow-up appointments. The review concludes with insights into future directions, including advancements in laser technology and emerging therapies, offering a glimpse into the evolving landscape of DR management. By addressing ongoing challenges and embracing innovative approaches, this review provides a comprehensive guide for clinicians, researchers, and healthcare practitioners who visually rehabilitate individuals struggling with PDR.

Treatment of Vitreous Hemorrhage due to Proliferative Diabetic Retinopathy in Cipto Mangunkusumo Hospital During Pandemic Era (March 2020 - March 2022)

Introduction &amp; ObjectivesProliferative diabetic retinopathy (PDR) is the most common etiology for vitreous hemorrhage (VH)and can be sight-threatening. Current treatment modalities for VH in PDR included anti-VEGFinjection, panretinal photocoagulation (PRP) laser, and vitrectomy. We conducted study to evaluatetreatment modalities and outcomes of VH in PDR during the pandemic era.&#x0D; MethodsA retrospective study of VH in PDR was conducted at Cipto Mangunkusumo Hospital, Indonesia,from March 2020 to March 2022. Primary treatment was the therapy planned at the initial visit,while secondary treatment was subsequent treatment after follow-ups. Good anatomical outcomewas defined as vitreous clearing at last follow-up, while functional outcome was visual acuity (VA)improvement in LogMAR.&#x0D; ResultsThis study included 83 patients (97 eyes), which is smaller than the previous study in our centerbefore the pandemic. Mean age was 54,28±8,57 years, with almost equal males and females. InitialVA was LogMAR 2,48 (0,15 – 2,80). The most frequent treatment for VH in PDR was vitrectomy(53,5%), followed by anti-VEGF injection, PRP laser, and observation. Glaucoma after vitrectomy wasthe most common complication (5,2%). Vitreous clearing was achieved in 85,5% of cases, which wassignificantly associated with vitrectomy surgery (p=0,013) and initial treatment time (p=0,023). TheVA improvement was LogMAR -0,48(-2,48–2,40) which was related to initial VA (p&lt;0.05), yet therewas no significant association with treatment modality.&#x0D; ConclusionVitrectomy is essential to achieve vitreous clearing in VH caused by PDR. Initial visual acuity, notthe type of treatment modality, is a significant factor in vision improvement.

Comparison of effect of machine muteness to reduce noise anxiety vs regular settings on patient compliance during pan-retinal photocoagulation.

This Quasi Experimental study was conducted at Major Eye Clinic, Gujranwala, from January to December 2022, to study the effect of muting the sound of Argon Laser machine on patient compliance and the pain felt during pan-retinal photocoagulation (PRP). Eighty patients were included in the study with proliferative diabetic retinopathy (PDR), retinal breaks, lattice and myopic fundus degenerations for which PRP was performed. A total of 80 patients were enrolled, who were divided in two groups with 40 patients in each group. Group A patients received muted machine settings, while group B underwent regular PRP. The mean age was 54.6±3.4 years. Sixty-eight (85%) cases were of PDR, 4 (5%) of retinal breaks, 3 (3.75%) of lattice degenerations associated with breaks, and 5 (6.25%) of laser barrage. In group A, 28 (70%) patients had grade 1 and grade 2 pain score, while in group B, 26 (65%) had grade 3 and grade 4 pain score. It was concluded that by eliminating machine sound, noise anxiety can be greatly reduced ensuring better patient cooperation.

Does Bevacizumab Improve Outcomes After Ahmed Glaucoma Valve Implantation for Refractory Glaucoma?: A Meta-Analysis.

Mean intraocular pressure (IOP), complete and overall success, mean IOP-lowering medications, incidence of hypertensive phase, and complications were found to be comparable between patients undergoing Ahmed glaucoma valve implantation (AGVI) with adjunctive bevacizumab versus AGVI alone. This meta-analysis aims to assess how adjunctive bevacizumab impacts the surgical outcomes of AGVI compared with AGVI alone in all subtypes of refractory glaucoma. A systematic search of databases for relevant randomized controlled trials (RCTs) was performed in March 2023. Primary outcomes included mean IOP and success rates. Secondary outcomes were mean IOP-lowering medications, incidence of hypertensive phase, and complications. Qualitative assessment, meta-analysis, subgroup analyses, and sensitivity analysis were performed. Five RCTs comprising 203 eyes were included in the quantitative analysis. Initial meta-analysis showed a strong yet nonsignificant trend (all P > 0.05) favoring adjunctive bevacizumab in all outcomes of interest. Significant heterogeneity was observed for mean IOP and success outcomes at all time points (all I2 > 50%). Subgroup analysis of the administration route revealed a reduced incidence of hyphaema in the intravitreal bevacizumab subgroup (odds ratio: 0.10; 95% CI: 0.02 to 0.59; P = 0.01) with significant heterogeneity persisting in the intravitreal bevacizumab subgroup for all measures (all I2 > 50%). Post hoc sensitivity analysis of studies without concurrent pan-retinal photocoagulation for mean IOP and success outcomes demonstrated more conservative effect sizes with a corresponding decrease in heterogeneity for all measures (all I2 < 30%). Published studies investigating the role of adjunctive bevacizumab show a strong trend to improve outcomes but contain a relatively small number of participants. This analysis underpins the need for an adequately powered RCT to explore the role of anti-vascular endothelial growth factor agents in AGVI surgery.

The progress of assessment methods and treatments of neovascular glaucoma secondary to central retinal vein occlusion.

Neovascular glaucoma is a condition that results from central retinal vein occlusion and often leads to blindness. Accurate evaluation and appropriate treatment are crucial for patients. However, there is currently no uniform and clear standard to differentiate between ischemic and non-ischemic central retinal vein occlusion. Also, the assessment of neovascular glaucoma progression is uncertain. Meanwhile, although pan-retinal photocoagulation is a standard treatment to prevent the onset of neovascular glaucoma, its actual efficacy and the timing of intervention remain highly controversial. It is still challenging to balance the risks of side effects in the visual field against the uncertain effectiveness of the treatment. This paper delves into the pathogenesis of neovascular glaucoma to understand the development of therapeutic approaches. By taking into account various assessment criteria of central retinal vein occlusion and neovascular glaucoma over the years, combining functional tests and morphological tests provides the most accurate and rigorous solution. The age of patients, the extent, location, and duration of retinal ischemia are the primary factors that affect the severity and extent of ischemic central retinal vein occlusion and induce serious complications. From the perspective of prevention and treatment, the ischemic index is closely related to the development of neovascularization. The paper provides essential insights into the mechanism, efficacy, complications, and optimal timing of pan-retinal photocoagulation. Comparing the treatment effects of pan-retinal photocoagulation and intravitreal anti-VEGF injections, we suggest a combination of both treatments to explore effective treatment with fewer side effects in the long term. This article details the debate on the above issues and explores ideas for the clinical diagnosis and preventive treatment of neovascular glaucoma that results from ischemic central retinal vein occlusion.

Occlusive retinal vasculitis as a presenting feature of primary vitreoretinal lymphoma relapse.

To report a case of primary vitreoretinal lymphoma (PVRL) relapse presenting as occlusive retinal vasculitis with secondary neovascularization. A retrospective case report. A Forty-year-old woman presented to the clinic with complaints of blurring of vision in the left eye for 4 months. Her best corrected visual acuity (BCVA) was 20/20 and 20/500 in the right and left eye, respectively. Both eyes' vitreous cavities showed vitreous opacities (2+). Both eyes fundus showed multifocal yellowish-white subretinal infiltration. A diagnostic vitreous and subretinal biopsy of the left eye revealed large lymphoid cells with CD20 positivity, confirming the diagnosis of PVRL. The patient received twelve intravitreal methotrexate (MTX) injections in both eyes over a course of 2 months, following which the lesions completely resolved. However, after 5 months, the left eye showed characteristic subretinal lesions along with perivascular exudates and retinal haemorrhages, diagnosed as PVRL relapse presenting as occlusive retinal vasculitis. Fluorescein angiography revealed retinal neovascularization (NVE), for which pan-retinal photocoagulation was performed along with repeated intravitreal MTX injection. PVRL is a great masquerader, and although rare, PVRL relapse can present as occlusive retinal vasculitis with secondary NVE, thereby delaying diagnosis and subsequent treatment.

Pain Management Strategies before Pan-Retinal Photocoagulation for Diabetic Retinopathy: A Systematic Review.

This systematic review aims to consolidate key findings regarding the efficacy of pain relief medications administered prior to pan-retinal photocoagulation (PRP) for diabetic retinopathy (DR). A comprehensive search of major databases from 1993 to 2023 was conducted. Clinical trials comparing pain relief drugs before PRP in patients diagnosed with DR requiring PRP treatment were eligible for inclusion. The assessment of pain scores involved the use of various scales, such as the visual analog scale (VAS), numerical rating scale (NRS), verbal rating scale (VRS), and other ordinal pain scales. In addition, laser parameters were taken into consideration during the analysis. Twenty-two clinical trials from initial 150 studies were included in the review. Nine studies evaluated the pain relief effects of nonsteroidal anti-inflammatories NSAIDs (selective NSAID and nonselective NSAID), two studies compared the effects of opioids (conventional opioids and atypical opioids), and eleven studies investigated the effects of benzodiazepines, lidocaine, and other sedatives. This review synthesizes findings from multiple studies reporting pain as an adverse outcome of PRP in patients with advanced DR. Based on the evidence from reviewed clinical trials, the administration of lidocaine 2% via transconjunctival, retrobulbar, or peribulbar block along with specific NSAIDs, such as topical ketorolac administrated 24 hours before treatment or oral diclofenac potassium (50 mg) prior to PRP, demonstrated beneficial effects among patients with DR.