Postoperative Cystoid Macular Edema Research Articles

Immunological Aspects of Macular Edema after Cataract Surgery in Patients with Diabetes Mellitus

Cytokines are polypeptides which are produced by a broad range of cells of the body. They play a key role in the formation and regulation of protective reactions. The researchers attempt to find predictors for the development of exudative-inflammatory reaction after surgery. It led to study of the eyes immunological status. It is known that a change of the pro- and anti-inflammatory cytokines balance leads to the blood-ocular barrier dysfunction that increases the inflammatory reaction. It is interesting the blood-ocular barrier has already damaged in diabetic patients. The paper examines the epidemiology, pathogenesis and possible methods of prevention the postoperative cystoid macular edema, presents investigations describing the change in the local cytokine status in patients with diabetes and the association between cytokines concentrations and the severity of diabetic retinopathy. The manuscript has shown possibilities of multiplex analysis, emphasized the features of individual cytokines and angiogenic factors, highlighted cytokines as predictors of macular edema after cataract surgery. The study of the cytokines role in the development of ophthalmic pathology led to the creation the new pathogenetically oriented eye diseases therapy. Further studies of the cytokine status in patients with macular edema after phacoemulsification are needed to determine the possible treatment methods.

"PI-less DMEK": results of Descemet's membrane endothelial keratoplasty (DMEK) without a peripheral iridotomy.

To assess Descemet's membrane endothelial keratoplasty (DMEK) without performing a peripheral iridotomy (PI) prior to or during surgery ("PI-less DMEK"). This retrospective study included consecutive patients that underwent PI-less DMEK by a single surgeon (E.L) between February 2016 and February 2017 at the Rabin Medical Center, a Tertiary Hospital. Intraoperative and postoperative complications were assessed. Thirty-one patients, mean age 75.9 ± 7.9 years with 58.1% female were included. Leading indications for surgery were pseudophakic bullous keratopathy (18/31) and Fuchs' endothelial dystrophy (9/31). Preoperative best-corrected distance visual acuity was 1.13 ± 0.59 logMAR (~6/80 Snellen). For 12/31 that had postoperative endothelial cell count measurements, cell loss was 49 ± 20%. Intraoperative complications included anterior chamber (AC) hyphema during graft insertion requiring reinsertion (n = 1), and minor hyphema from the main corneal incision (n = 1). Partial slit lamp gas evacuation was performed in all patients 1.5 h postoperatively. Postoperative complications included partial graft detachment requiring rebubbling (n = 5), self-resolving minimal peripheral graft detachment (n = 5), uncontrolled intraocular hypertension requiring trabeculectomy in a patient with a history of medically controlled glaucoma (n = 1), postoperative cystoid macular edema that resolved medically (n = 1) and graft failure 5 months postoperatively (n = 1). No patients developed pupillary block. Excluding graft failure (n = 1), preoperative amblyopia (n = 2) and premature loss to follow-up (n = 1), final corrected distance visual acuity was 0.18 ± 0.14 logMAR (~20/30 Snellen) with 44.4% reaching 6/7.5 (Snellen) or more. PI-Less DMEK is a safe, technically easy, and effective modification that avoids the time and complications associated with performing a PI before or during surgery.

Intraocular lens dislocation: a novel in-situ scleral refixation technique using a 25 Gauge trocar in the anterior chamber

ObjectiveIntraocular lens (IOL) repositioning using a closed-eye approach could be carried out in some selected cases. Our study focuses on the efficacy and safety of a IOL closed-eye repositioning technique...

Safety and Efficacy of Diode Laser Transscleral Cyclophotocoagulation in Eyes With Good Visual Acuity.

The main aim of this study was to evaluate the safety and efficacy of diode laser transscleral cyclophotocoagulation (TSCPC) in eyes with good visual acuity. A retrospective chart review identified patients who underwent TSCPC for uncontrolled intraocular pressure (IOP) from 2014 to 2016. Enrollment criteria included pretreatment best-corrected visual acuity (BCVA) of 20 of 40 or better, and a minimum of 6 months of postoperative follow-up. Thirty-three eyes of 33 patients(mean age, 72.1±16.0 y) were enrolled (mean follow-up 12.6±6.1 mo). The mean (SD) IOP was reduced 48.3% from 27.1 mm Hg (7.8) at baseline to 13.1 mm Hg (4.2) at last follow-up. Reduction of ≥1 glaucoma medications was achieved in 17 eyes (51.5%) at last follow-up. The cumulative probability of complete success (BCVA loss <2 Snelling lines, 20% reduction IOP, no reoperation for glaucoma, no IOP<5 mm Hg) was 78.8% and 50% at months 6 and 12, respectively. The cumulative probability of qualified success (BCVA≥2 lines with ≥20% reduction IOP, no reoperation for glaucoma, no IOP<5 mm Hg) was 90.1% and 81.3% at month 6 and 1 year, respectively. Significant vision loss, defined as BCVA≥2 lines, occurred in 33% of patients. The most common complications were postoperative iritic (56.3%) and cystoid macular edema (12.5%). TSCPC demonstrates a strong reduction in IOP and glaucoma medication use. However, with significant vision loss in 33% of patients, future prospective studies with a comparison group receiving traditional glaucoma surgery are needed to determine comparative safety and efficacy.

Patient Outcomes Following Micropulse Transscleral Cyclophotocoagulation: Intermediate-term Results.

To report the safety and efficacy outcomes following micropulse transscleral cyclophotocoagulation (MPTSCPC) procedure in patients with uncontrolled glaucoma. Longitudinal retrospective cohort, multicenter study. Patients with different types of glaucoma who underwent MPTSCPC with P3 probe between July 2015 and May 2017. Patients were treated by different glaucoma specialists from 5 different locations (Tulane Study Group). Data on preoperative characteristics, surgical procedure(s) performed, and postoperative outcomes were collected and analyzed. Statistical analysis using logistic regression and Kaplan-Meier analysis was performed with Stata software. Intraoperative and postoperative complications, intraocular pressure, visual acuity, need for incisional glaucoma surgery, need for repeat micropulse, and number of topical medications were studied. One hundred ninety-seven eyes from 161 patients were included. Median follow-up was 12 months [interquartile range (IQR), 6 to 14]. Glaucoma diagnosis included 141 primary open-angle glaucoma (POAG), 8 neovascular glaucoma, and 12 others. The total success rate was 71%. Two percent (4 patients) developed postoperative cystoid macular edema. Preoperative mean intraocular pressure (SD) was 22±9 and 16±6 mm Hg at last follow-up (P<0.001). Median preoperative logMAR visual acuity (IQR) was 0.4 (0.2 to 1.0) and 0.3 (0.2 to 1.0) at last follow-up (P=0.65, Wilcoxon signed-rank test). Median number (IQR) of topical medications was 3 (1 to 4) preoperative and 2 (1 to 3) at last follow-up (P<0.001). Kaplan-Meier analysis indicated 90% of patients free from repeat MPTSCPC at 12 months. Multivariable logistic regression identified 3 significant independent predictors of total success: diagnosis (P=0.011) (POAG), previous glaucoma surgery (P=0.003), and other concurrent procedures (P=0.013). Our large longitudinal cohort study has provided evidence that MPTSCPC is a safe and generally effective option in the treatment of POAG up to 12 months.

Topical non-steroidal anti-inflammatory drugs for the treatment of cystoid macular edema post Descemet's stripping automated endothelial keratoplasty.

To investigate the effectiveness of topical non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of cystoid macular edema (CME) post Descemet's stripping automated endothelial keratoplasty (DSAEK). Retrospective observational study METHODS: In this study of 334 patients who underwent DSAEK at the Baptist Eye Institute, Kyoto, Japan between July 2011 and December 2015, 18 patients with postoperative CME (determined by optical coherence tomography) treated with topical NSAIDs after the onset of CME were included. At CME onset, 17 of the 18 patients were treated with bromfenac eye drops and 1 was treated with nepafenac eye drops. Post initiation of treatment with topical NSAIDs, CME in 17 (94.4%) of the 18 patients improved at 1month and all cases completely recovered within 3months. At 12-months post initiation of treatment, 61.1% (n = 11) of patients achieved a visual acuity (VA) of 20/40 or better, and there was no significant difference of VA between the patients with or without an episode of postoperative CME (P = 0.55). The administration of topical NSAID eye drops was found to be effective in treating patients with CME post DSAEK.

The incidence and management of postoperative cystoid macular oedema: a retrospective audit

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The Effectiveness Analysis of Joint Use of Different Groups Anti-Inflammatory Drugs Treatment and Prevention of Cystoid Macular Edema in Patients after Phacoemulsification

Purpose: to analyze the results of the joint eye drops application of 0.09 % solution of bromfenac and 0.1 % solution of dexamethasone and subtenons triamcinolone injection for treatment and prevention of cystoid macular edema (CME) in patients after phacoemulsification.Patients and methods: The study included 914 patients (1147 eyes) which held phacoemulsification with IOL implantation. Depending on the postoperative treatment patients randomized into two groups. Patients of the first group received instillation of eye drops of antibiotics-fluoroquinolones and 0.1 % dexamethasone. Patients of the second group were prescribed instillation of eye drops of 0.09 % solution of bromfenac in addition to the treatment. In each group the patients diagnosed CME after phacoemulsification were divided into subgroups depending on the presence or absence of concomitant involution of retinal pathology. In cases of diagnosis of macular edema after phacoemulsification (2nd group of patients) periocular triamcinolone injections were made.Results. The efficacy of bromfenac was estimated by the number of cases of postoperative CME in the compared groups. In patients of the first group, complications occurred in 3.1 % of cases. In patients of the second group the number of complications was significantly lower (1.5 %), including a significant reduction in the incidence of CME observed in patients without concomitant of macular pathology (AMD and epiretinal fibrosis). A combination of steroid and NSAID in the treatment of CME provides the regression of macular edema in all patients, regardless of the presence of involution macular pathology. The positive effect of periocular triamcinolone injections in the treatment of anti-inflammatory eye drops was noted in 8 of 9 cases a month after the first injection.

Phacoemulsification in adult patients with post-uveitis complicated cataract

Objective: To evaluate the difficulties, complications and outcome of cataract surgery in patients with complicated cataract after anterior uveitis. Methods: A retrospective study on 37 patients who suffered phacoemulsification surgery for post-uveitis complicated cataract in the period 2009-2014 was performed. 43 eyes underwent surgery. Results: Posterior synechiae were present in 25 eyes. Posterior synechiolysis ensured large pupil in 15 eyes, and, in 14 eyes, the use of iris hooks or pupil expansion ring was necessary for surgery. Posterior capsule rupture was reported in 1 eye. Opacified and thick posterior capsule was noticed in 6 eyes. After surgery, transient rising of intraocular pressure was noticed in 4 eyes and prolonged postoperative inflammation was present in 3 eyes. Posterior capsule opacification was the most frequent issue (9 eyes) and cystoid macular oedema was reported in 2 eyes. Conclusions: Post-uveitis complicated cataract surgery presents specific difficulties and postoperative complications are present in these patients, like prolonged postoperative inflammation and cystoid macular oedema.

Long-term safety and efficacy of single-port pars plana anterior vitrectomy with limbal infusion during anterior segment surgery

To report the safety and efficacy of single-port pars plana anterior vitrectomy. Cincinnati Eye Institute, Cincinnati, Ohio, USA. Retrospective case series. Eyes that had anterior vitrectomy from September 2010 to June 2016 were electronically identified. Charts were reviewed for demographics, history of ocular trauma, underlying ocular or systemic comorbidity, surgical indications, outcomes, and postoperative complications. The mean postoperative follow-up was 10.9months with a mean patient age of 62.4years. Three hundred thirty-five eyes (97.7%) were scheduled as planned anterior vitrectomies, whereas 8 eyes (2.3%) were operated on unexpectedly after posterior capsule ruptures. Eighty-two eyes (23.9%) had a history of trauma. Twenty-five eyes (7.3%) had documented postoperative cystoid macular edema (CME), whereas 7 (2.0%) of these eyes had known preoperative CME. There were 3 eyes (0.9%) with retinal detachments and 1 eye (0.3%) with a retinal tear without detachment. There were no cases of endophthalmitis and no evidence of residual vitreous prolapse in the anterior chamber in any eye postoperatively. The safety and efficacy profile of a pars plana technique compared favorably against historical data for both coaxial and bimanual limbal clear corneal infusion and cutting. Sutureless pars plana anterior vitrectomy might be considered a safe and reliable solution for the anterior segment surgeon in managing vitreous prolapse during anterior segment surgeries.

Outcomes of sphincterotomy for small pupil phacoemulsification.

Sphincterotomy, an alternative to iris hooks or pupil stretching, is a technique that can aid in small pupil phacoemulsification. The incidence of post-operative complications of this procedure, however, has not been studied. Our study evaluates the post-operative outcomes of phacoemulsification surgery with adjunctive pupillary sphincterotomy. We conducted a retrospective review of case notes and Medisoft ® electronic record of patients that had undergone simultaneous sphincterotomy, phacoemulsification and intraocular lens (IOL) implantation by a single surgeon between March 2012 and February 2017. Our main outcome measures were post-operative ocular hypertension (IOP > 21 mmHg), uveitis and cystoid macular oedema (CMO). A total of 114 eyes of 114 patients were included in this study. The mean age was 81.2 years (range: 26-100). All patients had uncomplicated surgery. Transient (<1 month) ocular hypertension developed in five (4%) eyes. Sustained ocular hypertension (>1 month) occurred in one (1%) eye, which had pre-existing glaucoma. All four (4%) eyes that developed a persistent uveitis (>1 month) resolved with topical therapy except for one eye with a history of uveitis. The 6 (5%) eyes that developed CMO had a history significant for uveitis (n = 4), diabetic macular oedema (n = 1) and epiretinal membrane (n = 1). All CMO maculae resolved to their baseline. The incidence of post-operative complications following uncomplicated phacoemulsification and IOL implantation with pupillary sphincterotomy is low. The most important predisposing factors for development of a complication are ocular co-morbidities such as glaucoma, uveitis and the presence of a macular pathology.

Levels of Anti-Retinal Antibodies in Retinal Detachment and Proliferative Vitreoretinopathy

ABSTRACTPurpose: The purpose of the study is to investigate the correlation between intraocular anti-retinal antibodies and clinical measurements in patients with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy (PVR).Material and methods: Aqueous humor and vitreous samples were collected from patients with RRD, PVR, and from control subjects with macular hole. The levels of total protein (TP), IgG, and anti-retinal antibodies were determined with a bicinchoninic acid assay, enzyme-linked immunosorbent assay, and dot blot, respectively. Correlations between these measurements were assessed using Pearson’s correlation test. Analysis of variance followed by a post-hoc test or the Student t-test was used to compare differences between groups.Results: The levels of anti-retinal antibodies and IgG were correlated with each other (P < 0.010). The IgG concentration was higher in patients with PVR than in controls in both the aqueous humor (P < 0.001) and the vitreous (P < 0.001), but not in patients with RRD. Conversely, TP levels and anti-retinal antibodies in both ocular fluids from RRD and PVR patients did not significantly differ from the controls. In a subgroup analysis, vitreal anti-retinal antibody levels were correlated with average macular thickness in the re-attached macula following surgery for macula-off RRD/PVR (P = 0.012). Furthermore, patients with post-operative cystoid macular edema had a higher level of vitreal anti-retinal antibodies than those without (P = 0.009).Conclusions: Intravitreal anti-retinal antibodies were increased in the eyes with maculopathy after surgical intervention for RRD/PVR.

Anterior chamber lens implantation in vitrectomised eyes.

PurposeTo investigate long-term visual acuity (VA) outcomes and complication rates in vitrectomised eyes undergoing anterior chamber intraocular lens (ACIOL) insertion.Patients and methodsA single-centre, retrospective case series including all patients who had undergone ACIOL placement at the time of vitrectomy surgery or having had previous vitrectomy, between January 2007 and January 2013. Patients were identified using an electronic database and paper casefile notes were analysed for all patients. Patients were excluded if they had <3 months follow-up.ResultsTwo hundred and seventy-one patients were included in the analysis. Mean follow-up was 27 months. One hundred and forty-eight patients were vitrectomised before ACIOL placement. One hundred and twenty-three patients underwent vitrectomy at the time of ACIOL placement. Mean best-corrected visual acuity (BCVA) before ACIOL placement was 1.27 LogMar (SD 0.95). Mean BCVA at final follow-up was 0.51 LogMar (SD 0.66) (paired-sample T-test P<0.001). Forty (15%) patients developed postoperative cystoid macular oedema (CMO). Eighty-seven (32%) patients had an intraocular pressure (IOP) rise acutely post ACIOL insertion. Fifteen (6%) patients developed corneal decompensation. Five subsequently required corneal grafting. Sixteen patients had ACIOL displacement or instability requiring further surgery.ConclusionsACIOL insertion after vitrectomy is effective. Ninety-two per cent of patients maintained or gained VA, comparable to previous studies of ACIOL insertion post complicated cataract surgery. Raised IOP was the most frequent complication: 61 patients were on topical therapy at most recent follow-up. CMO tended to be acute. Corneal decompensation was infrequent.

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Epiretinal membrane (ERM) is a common retinal fibrotic disorder disease causing visual impairment and metamorphopsia. Recently, increasing attention has been devoted to ERM progression after uncomplicated cataract surgery. Cytokines, which play a role in diverse physiological and pathological activities in eyes, are suggested to be involved in these postoperative changes. However, few studies have investigated the post-cataract surgery cytokine expression changes in ERM eyes and their roles in the postoperative changes. The purpose of this study was to evaluate the aqueous levels of cytokines in eyes with idiopathic epiretinal membrane (iERM) both pre- and post-cataract surgery, and their correlations with postoperative iERM progression. In this study, aqueous humor (AH) samples were collected from iERM eyes (n = 25) and non-iERM eyes (n = 23) from 48 patients (48 eyes) undergoing uncomplicated cataract surgery preoperatively and 20 h postoperatively. Samples were analyzed for 48 cytokines with multiplex bead-based immunoassay. Correlations between cytokine level changes (postoperation vs. preoperation) and three-month postoperative best-corrected visual acuity (BCVA) and optical coherence tomography measure changes were evaluated in iERM eyes. We found that in iERM eyes, the levels of 4 cytokines exhibited significant elevations when compared with those in the controls (all p ≤ 0.0015) preoperatively. Postoperatively, the concentrations of 21 cytokines were higher than the preoperative levels in iERM eyes (all p ≤ 0.0015), among which GRO-α, IL-8, and MCP-3 levels showed more pronounced changes than the controls. Additionally, in iERM eyes, IL-4 level changes showed moderate positive correlations with MV (r = 0.492, p = 0.028) and MT (r = 0.481, p = 0.032) changes. LogMAR changes were positively correlated with IL-1α (r = 0.553, p = 0.011), IL-12(P40) (r = 0.544, p = 0.013), and MCP-3 (r = 0.588, p = 0.006) level changes. No significant cytokine-level-change differences were found between eyes with and without postoperative cystoid macular edema development. In conclusion, cataract surgery will bring great alterations to the specific intraocular cytokine microenvironment inherently in eyes with iERM. Many fibrotic and inflammatory cytokines showing elevated levels or relationships with clinical characteristics are suggested to be involved in the pathogenesis and post-cataract surgery progression of iERM; however, further investigations are needed to discern their real roles.

Prednisolone versus dexamethasone for prevention of pseudophakic cystoid macular edema

ObjectivePrevention of cystoid macular edema (CME) is important to achieve good surgical outcomes after cataract surgery. Although many options for management exist, control of postoperative inflammation with topical steroids is one of the most commonly employed. We evaluated the difference in incidence of pseudophakic CME in patients treated with prednisolone or dexamethasone topical steroids. MethodsThe study was a retrospective chart review of patients who had undergone phacoemulsification at the Cole Eye Institute of the Cleveland Clinic. Reviewable patient charts had to indicate the topical steroid used and whether or not an additional medication (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs]) was used after surgery. Excluded were patients who underwent combination procedures (e.g., trabeculectomy), perioperative anti–vascular endothelial growth factor or intraocular steroid, eyes with epiretinal membrane or prior retinal vein occlusion, those who developed postoperative endophthalmitis, patients with less than 3 months of follow-up, and patients who received topical NSAIDs. Pseudophakic CME was defined as new or worsening macular edema on optical coherence tomography within the first 3 months after cataract extraction. ResultsIn total, 1135 patient charts were included in the analysis; 721 patients were treated with prednisolone acetate, and 414 were treated with dexamethasone. Patient characteristics were similar between the 2 treatment groups. No significant difference was found in the rate of postoperative CME for patients receiving prednisolone or dexamethasone (4.0% vs 4.1%, p = 0.94). ConclusionsThere was no significant difference in the rate of pseudophakic CME when either prednisolone acetate or dexamethasone sodium phosphate was used after cataract surgery.

Predictive clinical factors of cystoid macular edema in patients with Descemet\u2019s stripping automated endothelial keratoplasty

The purpose of this present study was to investigate predictive clinical factors associated with cystoid macular edema (CME) post Descemet’s stripping automated endothelial keratoplasty (DSAEK) in a large case series. Of 393 consecutive patients who underwent DSAEK at Baptist Eye Institute, Kyoto, Japan between July 2011 and November 2016, 241 patients without CME at the pre- or early-postoperative periods were enrolled. The occurrence of anatomic CME was prospectively examined via optical coherence tomography (OCT). Possible predictive clinical factors for CME were analyzed by multivariate logistic regression analysis. At 1-month post DSAEK, CME occurred in 27 (11.2%) of the 241 patients. Multivariate analysis revealed that primary angle closure glaucoma (PACG) was significantly associated with postoperative CME (odds ratio = 6.4, P = 0.04). The findings of this study revealed that DSAEK in patients with PACG showed a high incidence of CME, thus indicating that they should undergo a careful postoperative observation of the macula via OCT.

Pseudophakic cystoid macular edema and spectral-domain optical coherence tomography–detectable central macular thickness changes with perioperative prostaglandin analogs

To define the incidence of cystoid macular edema (CME) and spectral-domain optical coherence tomography-detectable (SD-OCT) subclinical changes in central retinal thickness in patients using prostaglandin analog (PGA) eyedrops after phacoemulsification. Royal Bolton Hospital, Bolton, United Kingdom. Prospective case series. A consecutive analysis of the incidence of postoperative CME after phacoemulsification by a single surgeon was performed in eyes of patients using PGA eyedrops between March 2010 and January 2014. The presence of CME was determined using SD-OCT (Cirrus) 3weeks and 6weeks postoperatively. Exclusion criteria included preexisting pathology known to predispose to CME and previous ophthalmic surgery. The paired Wilcoxon signed-rank test was used to compare central retinal thickness measurements at baseline and 3weeks and 6weeks postoperatively. All 48 patients (mean age 78.4years; 60 eyes) had uneventful surgery. There were no cases of clinically significant CME. Subclinical CME detected by SD-OCT was confirmed in 2eyes of different patients (3.3% of eyes), 1 eye 3weeks postoperatively and another eye at 6weeks. Subclinical CME resolved in both cases within 8weeks. In both cases, the difference in central retinal thickness at baseline and 6weeks postoperatively was statistically significant (P<.05). The incidence of subclinical CME detectable on SD-OCT after routine phacoemulsification in patients using PGA eyedrops throughout the perioperative period was 3.3%. There were no cases of clinical CME. These findings might guide clinicians in their decision to use PGAs perioperatively.

The Role of Perioperative Anti-VEGF During Vitrectomy for Vitreous Hemorrhage in Relation to Postoperative Nonclearing Vitreous Hemorrhage and Cystoid Macular Edema

Purpose: To assess the role of perioperative anti–vascular endothelial growth factor (anti-VEGF) on the incidence of rebleed and foveal thickness in patients undergoing pars plana vitrectomy (PPV) for nonclearing vitreous hemorrhage due to retinal vascular disorders. Design: Retrospective, randomized, comparative interventional study. Methods: Three hundred twelve eyes were assigned to group A (eyes undergoing PPV without anti-VEGF, n = 165) and group B (eyes undergoing PPV with anti-VEGF, n = 147) and were followed up for a minimum of 6 months. The incidence of rebleed and 1 month postoperative central foveal thickness (CFT) was recorded and analyzed. Results: The incidence of postoperative vitreous hemorrhage (POVH) in group A was 21.81%, which was significantly ( P = .025) higher than in group B (12.24%). Mean CFT in group A (289.24 ± 49.47 μm) was higher as compared to group B (263.42 ± 94.42), but the difference was not statistically significant. Conclusion: Perioperative intravitreal anti-VEGF given at the end of the surgery significantly reduces the incidence of POVH and helps in achieving better CFT postoperatively.

Ocriplasmin treatment for vitreomacular traction in real life: can the indication spectrum be expanded?

To evaluate the efficacy of intravitreal ocriplasmin for the resolution of vitreomacular traction (VMT) with or without a full thickness macular hole (FTMH) in the clinical setting and to assess whether the indication spectrum of this treatment modality can be expanded beyond that of the MIVI-TRUST trials. The records of patients with VMT with or without FTMH, who were treated with intravitreal ocriplasmin were reviewed. Patients were divided in two groups. In the first group, VMT with or without FTMH was present without any other macular pathology. In the second group, VMT with or without FTMH occurred alongside of other macular disease including age-related macular degeneration, diabetic maculopathy and post-operative pseudophakic cystoid macular edema. Release of the VMT was achieved in 12/20 patients (12/20 eyes) of the first group. 16 eyes in this group met 3 or more criteria known to be associated with favorable prognosis after intravitreal ocriplasmin treatment. No cases of release of the VMT were observed in the second group, which included 15 patients (15 eyes). Significant improvement of visual acuity and reduction of the central macular thickness was observed only in the subgroup of eyes which responded to treatment. Concomitant macular pathology was a significant factor for treatment failure and we suggest that ocriplasmin should be regarded with caution in these cases. Careful patient selection for treatment with ocriplasmin using specific criteria in the clinical setting can provide superior results to those reported in the MIVI-TRUST trials.

Benchmarking cataract surgery outcomes in an ethnically diverse and diabetic population: final post-operative visual acuity and rates of post-operative cystoid macular oedema.

PurposeTo determine visual acuity and rates of post-operative cystoid macular oedema (CMO) in an ethnically diverse and predominantly diabetic population.MethodsThe study was undertaken over a one year period. Snellen visual acuity (VA) was measured pre and 4-8 weeks post-operatively and optical coherence topography (OCT) was performed at baseline and post-operatively. No eyes received prophylactic non-steroidal anti-inflammatory drugs (NSAIDs) prior to or after surgery.ResultsOut of 262 eyes, 59% were in the Black, Asian and minority ethnic group (BAME), 57% had a history of diabetes mellitus and 34% had pre-existing diabetic retinopathy. 76% of all eyes achieved 6/12 post-operative VA at the first postoperative review and the incidence of post-operative CMO within the study population was 7.6%. In patients with a history of diabetes mellitus the incidence of post-operative CMO was 10.7% compared to 3.5% in those without diabetes. This was found to be clinically significant (P=0.0297).ConclusionWe believe this is the first study to benchmark standards for care in this demographic of patients. A history of diabetes mellitus, irrespective of whether there is diabetic retinopathy or not, is an independent risk factor for the development of post-operative CMO in patients undergoing cataract surgery (P=0.0297). Ethnicity is not an independent risk factor for the development of post-operative CMO.