Preoperative Macular Thickness Research Articles

Predictive value of macular ganglion cell-inner plexiform layer thickness in visual field defect of pituitary adenoma patients: a case-control study

The present study explored the association between preoperative macular ganglion cell-inner plexiform layer thickness (GCIPL) and retinal nerve fiber layer thickness (RNFL) measured by optical coherence tomography (OCT) and the recovery of visual field (VF) defect after surgery in pituitary adenoma patients. This case-control study included patients with pituitary adenoma in the Neurosurgery Department of Shanxi Provincial People's Hospital between October 2019 and June 2021. Cranial MRI examination, three-dimensional OCT, and VF testing (Humphrey Field Analyzer II750) were performed before and at 6months after the surgery. Fifty-three pituitary adenoma patients (81 eyes) were enrolled; 15 patients (23 eyes) were in the visual field did not recover group (VFNR), and 38 patients (58 eyes) were in the visual field recovered group (VFR). The temporal RNFL (P = 0.002) and average RNFL (P = 0.009) in the VFNR group were significantly lower than in the VFR group. The superior nasal GCIPL (P = 0.001), inferior nasal GCIPL (P = 0.001) and average GCIPL (P = 0.01) were significantly lower in the VFNR group than in the VFR group (all P < 0.01).The multivariable logistic regression analysis showed that nasal inferior GCIPL was an independent risk factor for VF recovery (odds ratio (OR) = 1.376,95% confidence interval (CI):1.089-1.739,P = 0.007). In the received operating characteristics (ROC) analysis, the area under the ROC curve (AUROCs) was the highest for nasal inferior GCIPL (AUROC = 0.739). In patients who underwent resection of pituitary adenoma, nasal inferior GCIPL was an independent risk factor of visual field defect recover after surgery.

Effect of bariatric surgery on macular and peripapillary choroidal structures in young patients with morbid obesity

ObjectiveTo examine the effect of bariatric surgery on the macular and peripapillary choroid in the late postoperative period in young patients with morbid obesity and compare them with a healthy control group. MethodsThis prospective controlled study included 50 eyes of 25 young patients with morbid obesity and 50 eyes of 25 age and sex-matched healthy controls. Sleeve gastrectomy was performed on all patients with obesity. Preoperative and 6-month postoperative macular and peripapillary choroidal thickness, total choroidal area (TCA), luminal area (LA), and choroidal vascularity index (CVI) were performed. Results were compared with healthy controls by using enhanced depth imaging optical coherence tomography. ResultsChoroidal thickness and CVI values were smaller in patients with obesity in both macular and peripapillary areas compared with the healthy control group (both p < 0.001). There was a statistically significant increase in the macular and peripapillary choroidal thickness of patients with obesity when the preoperative and the postoperative 6-month values after bariatric surgery were compared (both p < 0.001). Also, it was found that bariatric surgery increased TCA and LA values in the macular and all sectors of peripapillary areas (all p < 0.001), and CVI values in the temporal and nasal peripapillary sectors (p = 0.007, p = 0.012, respectively). ConclusionsBariatric surgery was found to increase the macular and peripapillary choroidal thickness and the nasal and temporal peripapillary CVI values in young patients with morbid obesity in the late period. To the best of our knowledge, the current study has shown for the first time that bariatric surgery affects peripapillary choroid and CVI values.

Nocardia Endophthalmitis- Prophylactic Prevention with an Innovative Approach

Background: Nocardia is a common cause of endophthalmitis in southern India. It is an aggressive disease with a poor prognosis. Objective: This study was conducted using an amikacin antibiotic in the drip irrigation of balanced saline solution (BSS) during the surgery to prophylactically study the occurrence of Nocardia endophthalmitis and any subsequent toxic effects of the antibiotics used. Methods: Prospective study period was of 6 months, starting from July to December-2018. Preoperative and postoperative specular counts and macular thickness using Ocular Coherence Tomography (OCT) were compared with any incidence of Nocardia endophthalmitis. A total of 500 patients operated for manual SICS were randomly assigned into 2 groups. The first group of 250 patients received antibiotic amikacin added to the Balanced Saline Solution (BSS) irrigating solution throughout the course of the surgery. The second control group received no antibiotics. Manual SICS was performed on all 500 patients by a single surgeon and was found to be uneventful. Pre- and postoperative corneal endothelial cell density and mean macular thickness using OCT were taken and recorded of all the patients, respectively, and data obtained were statistically compared. Results: No incidence of Nocardia endophthalmitis among the cataract surgeries operated was found. There was no drug-related toxicity to the cornea or macula. Furthermore, no incidence of Nocardia endophthalmitis has been reported since 2018 after using antibiotics. Conclusion: A simple routine of adding amikacin in the drip prophylactically during the course of surgery helped us prevent Nocardia endophthalmitis with no side effects. Also, it will be an innovative technique that is economically feasible and effective in regions where Nocardia endophthalmitis is prevalent.

The role of optical coherence tomography in the evaluation of compressive optic neuropathies.

Optical coherence tomography (OCT) is a noninvasive imaging tool routinely used in ophthalmology that provides cross-sectional images of the retina. Compression of the anterior visual pathways results in progressive thinning of the retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) and this review will highlight the utility of OCT in evaluating patients with this condition. The RNFL and macular GCC have been found to highly correlate with visual function in patients with compressive optic neuropathies. Preoperative RNFL and macular GCC thickness have emerged as the most reliable and consistent prognostic factors for visual recovery after surgery. Patients with an otherwise normal neuroophthalmic examination, including automated perimetry, may have macular GCC or RNFL thinning as the only manifestation of compression, enabling compressive optic neuropathies to be diagnosed at an earlier stage and managed accordingly. Recent findings indicate that OCT is an important tool in the evaluation of patients with compressive optic neuropathies, particularly for prognosis in patients with visual field defects and diagnosis in patients with preserved or mildly reduced visual function. Anatomical changes detected by OCT may precede visual loss and allow for earlier diagnosis and presumably better visual outcomes.

Long term clinical observation on postoperative microstructural change of macula lutea in treatment of idiopathic macular epiretinal membrane

Objective: To evaluate the relationship between the structure of macular region and prognosis after vitrectomy in idiopathic macular epiretinal membrane patients. Methods: Retrospective case series study. The cases of 74 idiopathic macular epiretinal membrane patients (31 female patients, 43 male patients, aged 68.1±6.9) who received surgery treatment in our hospital during January 2013 and December were collected and analyzed. Ophthalmic routine examination and optical coherence tomography (OCT) have been conducted for all patients prior to operation. All eyes underwent vitecrtomy and macular epiretinal membrane peeling. During the 12 months follow up, the preoperative and postoperative data including best corrected visual acuity (BCVA), foveal thickness, changes of morphology in ellipsoid zone were observed and analyzed. All the patients were divided into two groups, continuous group (52 patients) and discontinuous group (22 patients), based on the preoperative continuity status of ellipsoid zone. The data of preoperative macular retinal thickness, the relationship between age and course of the disease, preoperative BCVA and postoperative BCVA were analyzed statistically with repeated ANOVA method. The postoperative BCVA were analyzed statistically with t test mtehod, based on the different grouping of continuity status of ellipsoid zone. Results: The preoperative LogMar BCVA, and the postoperative LogMAR BCVA of 1 month, 3 month, 6 month and 12 month after operation were 0.59±0.26, 0.63±0.34, 0.46±0.22, 0.45±0.23, 0.41±0.23 (F=25.122, P<0.05) respectively. The preoperative foveal thickness, and the postoperative foveal thickness of 1 month, 3 month, 6 month and 12 month after operation were (468.12±73.07), (371.57±57.09), (320.57±65.88), (294.85±69.36), (283.5±66.56)μm (F=8.802, P<0.05), the difference between the figures are of statistical significance. The postoperative BCVA of continuous group (0.34±0.27) improved significantly, as compared to the BCVA of discontinuous group (0.62±0.24) (t=-4.209, P<0.05). There is no obvious relationship between the degree of preoperative macular edema and postoperative visual function (r=0.015, P> 0.015). Seven patients still have macular edema one year after surgery. Conclusion: The postoperative visual function in patients with idiopathic macular epiretinal membrane has negative correlation with preoperative thickness of fovea, and has positive correlation with continuity of ellipsoid zone. (Chin J Ophthalmol, 2018, 54: 258-262).

Recurrence rate and need for reoperation after surgery with or without internal limiting membrane removal for the treatment of the epiretinal membrane

PurposeTo compare the recurrence rate and need for reoperation after epiretinal membrane surgery with and without removal of the internal limiting membrane.MethodsIn this retrospective study, 125 patients operated for epiretinal membrane removal were evaluated, with a minimum 6-month follow-up. Removal of the epiretinal membrane (ERM) was performed in 78 patients, while 47 had removal of the epiretinal membrane associated with internal limiting membrane peeling (ERM + ILM).ResultsThe mean age in the ERM group was 65.8 years old, ranging from 41 to 80 years old. In the ERM + ILM group, the mean age was 67.2 years old, ranging from 52 to 82 years old. The mean preoperative visual acuity in the ERM group was 20/80p, and in the ERM + ILM group, it was 20/80. The mean postoperative visual acuity in both groups was 20/30. The mean preoperative macular thickness in the ERM group was 467 µm ranging from 281 to 663 µm; in the ERM + ILM group, the preoperative macular thickness was 497 µm, ranging from 172 to 798 µm. After surgery, a reduction in macular thickness was observed in both groups. In the ERM group, the mean macular thickness reduction was 361 ± 101. µm, whereas in the ERM + ILM group, it was 367 ± 75.2 µm. Twenty-two patients presented with a recurrence of epiretinal membrane, of which 16 (20.5%) were from the ERM group and 6 (12.8%) were from the ERM + ILM group (p = 0.39); one patient (2%) was retreated in the ERM + ILM group, whereas 5 patients (6%) where retreated in the ERM group.ConclusionWe postulate that ILM peeling for the treatment of epiretinal membrane is not a relevant factor either for visual recovery or macular thickness reduction, but it may reduce the recurrence and reoperation rate.

Refractive outcome comparison between vitreomacular interface disorders after phacovitrectomy

To compare the refractive accuracy of intraocular lens (IOL) power calculations between patients with vitreomacular interface disorders who had phacovitrectomy for vitreomacular traction (VMT), epiretinal membranes (ERM), and macular holes. Baskent University Department of Ophthalmology, Ankara, Turkey. Retrospective case series. Refraction results 8weeks postoperatively were compared between phacovitrectomy (3 study groups comprising eyes with VMT with intrafoveal pseudocysts, ERM, or medium-to-large macular holes) and phacoemulsification (control group comprising eyes having phacoemulsification only). The IOLMaster 700 partial coherence interferometry (PCI) device and Haigis formula were used for all calculations. This study included 100 eyes (100 patients), 25 in each of the 4 groups. There was no statistically significant difference in axial length (AL) between the groups (P=.305). Differences in the preoperative macular thickness were statistically significant between all groups except between the macular hole and VMT groups. Most eyes (92%) in the VMT and macular hole groups and all eyes in the VMT and phacoemulsification groups achieved a final refraction within ±1.00 diopter of the refractive aim. The mean prediction error and the mean absolute error did not differ significantly between the groups. In all groups, there was no significant correlation between prediction error and age, AL, preoperative refractive error, or preoperative or postoperative macular thickness (P>.05). The IOL power calculation with PCI yielded no difference in postoperative refraction errors between the vitreomacular interface disorders. There was no correlation with preoperative refraction, age, or preoperative or postoperative macular thickness.

Evaluation of Macular Thickness in Patients Underwent Combined Cataract and Epiretinal Membrane Surgery

Cataract and idiopathic epiretinal membrane (ERM) are eye diseases especially seen in elderly people. We may observe them at the same time. Both surgeries may affect macular thickness and combining surgery may worsen macular edema. Total 54 cases that were operated for ERM, combined with cataract surgery or vitrectomy only, were included the study. Pre-operative, post- operative 1st week, 1st month, 3rd month and 6th month macular OCT images were taken. Macular thickness (MT) was decreased in both groups at the end of six months. When we compared the both groups measurements no difference was found. Pre-operative MT values and last visual acuity were correlated weakly. Visual acuity was also increased in both groups. But this was not significant between groups. In this study we found that combined surgery was not increasing macular thickness more than vitrectomy only in ERM surgery.

Postoperative refractive error after phacovitrectomy for epiretinal membrane with and without macular oedema.

This study was initiated to investigate whether the presence of macular oedema influenced intraocular lens (IOL) power calculation in eyes with epiretinal membrane. The files of patients undergoing combined phacoemulsification were retrospectively reviewed. Two groups were defined according to presence of macular oedema. The main outcome measure was the IOL power prediction error (PE). Secondary outcome measures were the correlation between preoperative macular thickness, absolute change of macular thickness and dioptric shift. The mean postoperative PE achieved with the Haigis formula was compared with the PE that would have been obtained had the SRKII and HofferQ formulas been used. We investigated 47 eyes of 47 consecutive patients. Regardless of the IOL formula used, the PE was on average higher in eyes without macula oedema (group 1). The myopic dioptric shift was dependent on preoperative macular thickness and absolute change of macular thickness. This association was more markedly pronounced in group 1. Increased retinal thickness is the main cause for underestimation of the cornea-photoreceptor layer distance, and therefore could contribute to inaccuracy in IOL power calculations. The current results show that a myopic shift tends to be less pronounced in cases where a macula oedema is present. Eyes with pure traction have less predictable refractive results in terms of higher PE and dioptric shift.

Evaluation of macular thickness changes after intracameral vancomycin in cataract surgery.

The purpose of this study was to determine the effect of intracameral injection of vancomycin at the end of routine cataract surgery on macular thickness using spectral domain optical coherence tomography. This prospective comparative case series included sixty eyes of 42 patients undergoing cataract surgery. Eyes were divided into two groups: 30 eyes (Group 1) received an intracameral injection of vancomycin (1 mg/0.1 ml) at the end of surgery, and 30 eyes (Group 2) received an intracameral injection of cefuroxime (1 mg/0.1 ml). Visual acuity, average macular thickness, and retinal thickness in 9 Early Treatment Diabetic Retinopathy Study (ETDRS) sectors were measured at baseline, and 1 week, 1 month, and 3 months after surgery. There were no differences in age, gender, visual acuity, and preoperative macular thickness between groups. In Group 1, average macular thickness significantly increased 1 month after surgery compared with baseline (P = 0.000) and then stabilized. Retinal thickness significantly increased in most of the ETDRS map sectors at 1-month follow-up. In Group 2, there was a significant increase in average macular thickness 1 month after surgery compared with baseline (P = 0.037). Likewise, retinal thickness increased in most of the ETDRS subfields at 1 month. Postoperative retinal thickness values and best-corrected visual acuity were similar in both groups 1 week, 1 month, and 3 months after surgery. Intracameral injection of vancomycin at the end of cataract surgery showed comparable effects to cefuroxime in terms of macular thickness changes and visual acuity.

Role of ganglion cell complex in visual recovery following surgical internal limiting membrane peeling.

To investigate the Ganglion Cell Complex (GCC) thickness change and visual recovery correlation after surgery for an idiopathic epiretinal membrane (ERM). In this prospective, observational, case control study 30 eyes underwent vitrectomy for idiopathic ERM. We analysed best-corrected visual acuity (BCVA), mean macular thickness and mean GCC thickness one day before surgery, seven days and six months after surgery. Internal segment/outer segment junction, external limiting membrane, cone outer segment tips defects and intraretinalfluid were also investigated throughout the follow-up. Baseline GCC thickness was higher in patients with ERM (130 ± 13 μm) compared with healthy eyes (94 ± 5 μm; p < 0.0001). GCC thickness decreased after surgery to 89 ± 11 μm (p < 0.0001), reaching a value similar to controls (p = 0.12). Preoperative macular thickness was 318 ± 32 μm and decreased to 281 ± 18 μm (p < 0.0001), remaining significantly higher than controls (260 ± 8 μm; p < 0.0001). The GCC proportion of the whole macular thickness was also reduced six months after surgery (p < 0.0001). Post-operative BCVA gain showed direct correlation with GCC reduction (R = 0.67, p < 0.0001), but did not correlate with the mean macular thickness reduction (R < 0.01, p = 0.97). Ganglion cell complex thickness is higher in eyes with idiopathic ERM, and after surgery turns back to similar values of healthy eyes. Post-operative GCC reduction is proportionally higher than thinning of the whole retina, and this reduction is correlated with visual restoration.

The effect of intracameral anesthesia on macular thickness and ganglion cell-inner plexiform layer thickness after uneventful phacoemulsification surgery: prospective and randomized controlled trial

To evaluate the effect of intracameral lidocaine anesthesia on macular thickness and macular ganglion cell-inner plexiform layer (GC-IPL) thickness following uneventful phacoemusification in healthy subjects. This is a prospective, randomized and double- masked study. One hundred eyes of 74 consecutive patients were randomized to receive intracameral preservative-free lidocaine 1% (intracameral lidocaine group) or intracameral injection of balanced salt solution (sham injection group) at the time of the phacoemulsification surgery. Preoperative and postoperative macular thickness analyses with spectral domain optical coherence tomography (SD-ODT) were performed and the results between the two groups were compared. Postoperatively, both the central foveal thickness (CFT) and the thickness of perifoveal macula were significantly improved in both groups (p < 0.001). There was no statistically significant difference between CFT and the inner and outer macular zone thicknesses of the two groups at any follow-up time. In both groups, GC-IPL thickness was significantly increased at the first week and first month visits (p < 0.001). There was no statistically significant difference between GC-IPL thickness measurements of the two groups at any follow-up time. The current study demonstrated that supplementary intracameral lidocaine 1% did not cause more macular thickening than the intracameral sham injection during a follow-up period of 3months. The present study also showed a tendency for a transient increase in high definition SD-OCT-based GC-IPL thickness measurements within a few months following cataract surgery under both intracameral lidocaine anesthesia and intracameral sham injection.

Impact de la chirurgie de la cataracte sur l’épaisseur maculaire centrale chez le patient diabétique sans rétinopathie diabétique

To determine whether cataract surgery increases macular thickness in diabetic patients without preoperative retinopathy or macular edema. In a prospective, non-controlled study, we compared preoperative macular thickness as measured by OCT to that measured 3 and 6 months after cataract surgery. Thirty-six eyes of 21 patients (ten men and 11 women) were included in the study from November 2008 to May 2009. Mean foveolar thickness measured preoperatively was 198 μm (± 18.5 μm) compared with 202 μm (±17.2 μm) 3 months postoperatively and 212 μm (± 18.9 μm) 6 months postoperatively. In our study, we do not show a significant increase in central foveolar thickness 3 months after cataract surgery; however, we do measure a significant increase at 6 months. This increase in thickness is similar to that found in the literature after cataract surgery in a non-diabetic population. Cataract surgery in diabetic patients without preoperative retinopathy does not appear to induce significant macular thickening compared to non-diabetic patients. The period prior to any diabetic retinopathy or maculopathy seems to be the most amenable to cataract surgery when necessary.

Safety of Prophylactic Intracameral Moxifloxacin Use in Cataract Surgery

To evaluate posterior and anterior segment safety of an intracameral injection of moxifloxacin as prophylaxis for endophthalmitis in cataract surgery. In this study, 60 eyes of 60 patients were included. In the first group, only 5% povidine iodine drop was administrated to 30 patients at the end of the surgery, while 30 patients were treated with intracameral moxifloxacin (250 μg/0.050 mL) additionally in the second group. Visual acuity, intraocular pressure, corneal pachymetry, corneal clarity, and edema and retinal thickness were evaluated preoperatively and for day 3 postoperatively for each group and were compared. Mean preoperative visual acuity was 0.7 ± 0.9 LogMAR in both groups 1 and 2, while mean postoperative visual acuity was 0.05 ± 1.00 LogMAR in both groups. Preoperative and postoperative intraocular pressure averaged 13.2 ± 2.0 and 13.2 ± 2.1 mmHg, respectively, in the first group, while preoperative and postoperative intraocular pressure was 14.9 ± 2.1 and 14.3 ± 2.0, respectively, in the second group. Preoperative and postoperative visual acuity changes and intraocular pressure changes were not significantly different between 2 groups. There was no single case of corneal edema. In the first group, preoperative pachymetry was 523 ± 44 and postoperative pachmetry was 536 ± 45 μm, while in the second group preoperative pachymetry was 527 ± 43 and postoperative pachymetry was 543 ± 42 μm. Preoperative and postoperative pachymetry changes were not significantly different between 2 groups. Mean preoperative macular thickness in the first group was 188 ± 7.73 μm, while it was measured as 189 ± 7.75 μm postoperatively. In the second group, mean preoperative macular thickness was 188 ± 8.89 μm, while it was 189 ± 9.61 μm postoperatively. Preoperative and postoperative optical coherence tomography (OCT) measure changes were not significantly different between the 2 groups. No study-related adverse events were noted. There was no increased safety risk associated with a 250 μm/0.050 mL intracameral injection of moxifloxacin, which appears to be safe in the prophylaxis of endophthalmitis after cataract surgery.

Influence of Cataract Surgery on Macular Thickness — A 3-Month Follow-Up

This prospective follow-up study evaluated the longer term changes to macular thickness and volume following cataract surgery. The study included 23 patients (23 eyes) who underwent ambulatory cataract surgery with phacoemulsification and intraocular lens implantation, followed by a scheduled optical coherence tomography measurement of macular thickness and volume after 3 months. Results were compared with preoperative data and measurements taken at 1 month after surgery, which were recorded in a previous study. A comparison of preoperative macular thickness values with those at 3 months after surgery demonstrated that the latter values remained greater in all macular regions except the superior outer macula, and that the differences were significant in the fovea, nasal inner macula and inferior outer macula. When macular thickness at 3 months after surgery was compared with that measured at 1 month, decreases were observed in all perifoveal areas, suggesting the reversible nature of cataract surgery-related macular thickness changes.

Pars plana vitrectomy and internal limiting membrane peeling for macular edema secondary to retinal vein occlusion

Purpose:To evaluate the effects of vitrectomy and internal limiting membrane peeling for treatment of macular edema secondary to retinal vein occlusion (RVO).Methods:Nine cases of visual loss due to macular edema caused by central retinal vein occlusion or branch retinal vein occlusion underwent pars plana vitrectomy with removal of the preretinal hyaloid, peeling of the internal limiting membrane stained with indocyanine green dye, air–fluid exchange, and postoperative prone positioning. Best-corrected visual acuity (BCVA) and central foveal thickness by optical coherence tomography were measured pre- and postoperatively then compared to assess the outcome of surgery.Results:In all cases intraretinal blood and retinal thickening diminished within 2 months of surgery. Visual acuity improved in all of the central retinal vein occlusion cases and 3/6 branch retinal vein occlusion cases. The decrease in macular thickness was statistically significant (mean postoperative macular thickness 361 ± 61.1 versus mean preoperative macular thickness 563.9 ± 90.0, P = 0.001, t-test). The improvement in BCVA was not statistically significant (mean preoperative BCVA in LogMAR 1.23 ± 0.29 versus mean postoperative BCVA in LogMAR 1.06 ± 0.49, P = 0.09, t-test).Conclusion:In eyes with macular edema secondary to RVO, pars plana vitrectomy with internal limiting membrane peeling can resolve macular edema, but the improvement in BCVA was not statistically significant in this study.

Pars-plana-Vitrektomie mit ILM-Peeling versus intravitreale Triamcinolon-Injektion bei diffusem diabetischem Makulaödem

Visual outcome and anatomic results in patients with diffuse diabetic macular oedema (DDME) were evaluated after vitrectomy with internal limiting membrane (ILM) peeling versus intravitreal triamcinolone acetonide (TA). A prospective, non-randomised pilot study included 41 eyes (35 patients) with clinically significant DDME. In 24 eyes (group A) we performed pars plana vitrectomy with ILM peeling. Seventeen eyes (group B) received an injection of 10 mg TA. Best corrected visual acuity and central macular thickness (measured with OCT) were determined preoperatively as well as 1 and 4 months postoperatively. In group A, OCT showed a macular thickness of 403 +/- 142 microm preoperatively. Best corrected visual acuity was 0.24 +/- 0.18. One month after surgery, macular thickness decreased to 311 +/- 62 microm (p = 0.06 ns) and visual acuity was 0.17 +/- 0.14 (ns). Four months after surgery, macular thickness remained significantly lower compared with preoperative values, at 307 +/- 161 microm (p = 0.012). There was a tendency towards a higher visual acuity of 0.30 +/- 0.26 (p = 0.32 ns). Before TA injection, macular thickness in group B was 551 +/- 180 microm and visual acuity was 0.19 +/- 0.14. One month after TA, macular thickness decreased to 242 +/- 82 (p = 0.001) microm while visual acuity increased to 0.31 +/- 0.21 (p = 0.005). At 4 months follow-up, group B showed recurrence of macular oedema. Compared with the preoperative findings macular thickness was significantly lower (368 +/- 159 microm; p = 0,001). Best corrected visual acuity after 4 months was 0.27 +/- 0.17 and did not differ significantly from the preoperative visual acuity (p = 0.033 ns). Intravitreal TA as a single treatment reduces the extent of DDME within a short time after surgery. These promising results may not be stable during long-term follow-up, necessitating in many cases a re-injection of TA. Macular oedema reduction after vitrectomy with ILM peeling, however, remains stable for more than 4 months and, therefore, offers more permanent results. However, none of these treatments facilitated a significant visual acuity restoration 4 months postoperatively.

PREVENTION OF VISION LOSS AFTER CATARACT SURGERY IN DIABETIC MACULAR EDEMA WITH INTRAVITREAL BEVACIZUMAB

To determine whether an intravitreal bevacizumab injection after phacoemulsification can improve cataract surgery visual outcomes in patients with diabetic macular edema by acting on the degree of edema. Fundación Oftalmológica del Mediterráneo, Valencia, Spain. We selected 26 consecutive diabetic patients with nonproliferative diabetic retinopathy and macular edema who were to undergo cataract surgery, and we divided them into two randomized groups to be studied prospectively. Group I included 13 eyes that were injected with intravitreal bevacizumab upon completion of cataract surgery; Group II included 13 control eyes that were injected with balanced salt solution. Preoperative macular thickness was 282.62 microm +/- 57.64 in Group I and 310.38 microm +/- 82.99 in Group II. Preoperative Snellen best-corrected visual acuity was 0.27 +/- 0.17 and 0.24 +/- 0.16 in Groups I and II, respectively. Best-corrected visual acuity at 3 and 6 months was better in Group I--0.4 +/- 0.28 and 0.4 +/- 0.27--whereas poorer results were observed in the control group--0.21 +/- 0.13 and 0.14 +/- 0.13. These mean macular thickness values differed significantly between groups at 3 months (P = 0.040) and 6 months (P = 0.004). Optical coherence tomography measured macular thickness was also better in Group I, 292.46 +/- 104.75 microm at 3 months and 277.62 +/- 92.99 microm at 6 months. For Group II, the results were 367.62 +/- 75.24 microm at 3 months and 387.46 +/- 74.11 microm at 6 months. These mean macular thickness values differed significantly between groups at 3 months (P = 0.046) and 6 months (P = 0.002). Intravitreal bevacizumab immediately after phacoemulsification prevents exacerbation of the macular edema seen in many diabetic patients undergoing cataract surgery. In addition, this effect seems to hold in the short term.

Effect of Posterior Capsular Opacification Removal on Macular Optical Coherence Tomography

To evaluate the influence of posterior capsular opacification (PCO) on macular optical coherence tomography (OCT) imaging quality and measurements of macular retinal thickness. In this prospective interventional case series, 32 eyes of 23 patients with PCO were recruited. Best-corrected visual acuity (BCVA), a complete ophthalmologic assessment, and macular OCT scans (OCT Stratus 3000) before and after Nd:YAG capsulotomy were performed. Two parameters for image quality (signal strength (SS) and number of tomographic messages) and 10 macular retinal thickness measurements were compared. Spearman correlations between BCVA and SS and macular retinal thickness measurements before and after capsulotomy were also performed. PCO removal was associated with an increase of best-corrected visual acuity (p<0.0001). The mean SS (n=32) went from 3.34+/-2.31 to 6.38+/-1.93 (p<0.0001) after Nd:YAG capsulotomy. The SS improved in 26 of 32 eyes. No significant difference between mean preoperative and postoperative macular retinal thickness measurements was observed (p<0.05) in valuable scans. Before capsulotomy, a correlation existed between BCVA and SS. After capsulotomy this correlation was no longer found. OCT image quality is influenced by PCO. Nd:YAG capsulotomy results in a measurable improvement in SS and improvement in the number of valuable examinations. Valuable OCT scans in patients with PCO seem to yield reliable measurements of macular retinal thickness even in the presence of severe PCO. The correlation between BCVA and SS before capsulotomy suggests that the SS could be considered an objective indicator of the degree of PCO.

Evaluation of the Efficacy of Vitrectomy for Persistent Diabetic Macular Edema and Associated Factors Predicting Outcome

PurposeTo evaluate the efficacy of vitrectomy for persistent diabetic macular edema after laser photocoagulation or intravitreal triamcinolone injections and to determine the demographic and ocular factors that influence functional and anatomical outcomes.MethodsWe retrospectively evaluated 55 eyes (51 patients) that had persistent diffuse macular edema after laser photocoagulation or intravitreal triamcinolone injections. We compared preoperative and postoperative best corrected visual acuity and macular thickness by Optical Coherence Tomography and investigated factors including patient's age, presence of vitreomacular traction, grade of diabetic retinopathy, and intraoperative internal limiting membrane removal that may influence the surgical results.ResultsThe mean preoperative BCVA (log MAR) was 0.91±0.40 (0.8-1.2). The BCVA improved to 0.72±0.39 (0.3-1.2). The mean preoperative macular thickness was 440±130 (202-805) μm and the mean macular thickness decreased to 306±97 (136-580) μm postoperatively. The eyes showed statistically significant improvement in BCVA and central macular thickness (p<0.001). Preoperative better BCVA was associated with an improved postoperative visual acuity. (p=0.04). No other covariates were found to be statistically significant factors for prognosis of postoperative BCVA.ConclusionsIn eyes with persistent diabetic macular edema after laser or IVTA injections, vitrectomy was effective for decreasing macular thickness and improvement of vision. The visual improvement after vitrectomy was associated with the preoperative better BCVA.