Reduction In Central Foveal Thickness Research Articles

Efficacy of anti-VEGF intravitreal injection in traumatic submacular hemorrhage: a retrospective study.

In this study we investigated the efficacy of short-term intravitreal injections of anti-vascular endothelial growth factors (anti-VEGF) in treating traumatic submacular hemorrhage. A total of 115 patients were diagnosed with submacular hemorrhage between 2018 and 2022 at Shenzhen Eye Hospital. In a retrospective analysis, we examined 13 of these patients who presented with submacular hemorrhage and choroidal rupture due to ocular trauma. Eight patients were treated with intravitreal anti-VEGF injection and 5 with oral drugs. We systematically analyzed changes in their ocular conditions pre and post-treatment. The evaluations encompassed best-corrected visual acuity (BCVA), optical coherence tomography, fundus fluorescein angiography, and retinal imaging. The 13 patients diagnosed with submacular hemorrhage comprised of 10 males and 3 female, with their age ranging between 27 and 64years, with an average age of 38.1years (standard deviation [SD]: 11.27). A statistically significant reduction in central foveal thickness (CFT) was observed following intravitreal injections of anti-VEGF drugs (P = 0.03). In control group, the CFT was reduced without statistical significance (P = 0.10). The BCVA of the patients in treatment group improved significantly from 1.15 (SD: 0.62. Range: 0.4-2) to 0.63 (SD: 0.59. Range: 0.1-1.6), indicating an average increase of 4.13 lines (SD: 3.36. Range: 0-9) as measured by the visual acuity test using an eye chart (P = 0.01). The difference between baseline visual acuity and final visual acuity was not statistically significant in control group (P = 0.51). Short-term administration of anti-VEGF drugs exhibited significant efficacy in reducing submacular hemorrhage following ocular trauma and enhancing visual acuity.

Exploratory analysis of choriocapillaris vasculature as a biomarker of idiopathic epiretinal membrane.

To investigate the preoperative choriocapillaris perfusion (CCP) as a biomarker in patients with idiopathic epiretinal membrane (iERM). 28 patients (28 eyes) with unilateral iERM who received pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling were included for retrospective observational study. Optical coherence tomography (OCT) and angiography (OCTA) was performed before and after PPV. Area, perimeter, and circularity of superficial foveal avascular zone (FAZ) were analyzed preoperatively in both eyes using OCTA. Preoperative CCP was also analyzed with binarized en-face OCTA images. Measurements of best-corrected visual acuity (BCVA) and central foveal thickness (CFT) by OCT were conducted at the baseline and 6 months following the surgery. The correlations of preoperative OCT parameters with postoperative BCVA and CFT reduction were analyzed. CCP was significantly lower (p < 0.001) and FAZ had shrunk (p < 0.001) in eyes with iERM compared to unaffected fellow eyes before surgery. BCVA and CFT became significantly improved after surgery (p = 0.001, p < 0.001). Multiple regression analysis revealed that preoperative CCP was significantly related with BCVA improvement (β = 0.185, p = 0.005), postoperative BCVA (β = 0.108, p = 0.023) and ratio of post- to preoperative CFT (β = 0.106, p = 0.044). Preoperative CCP is a biomarker for poor functional and anatomical prognosis after surgery in iERM.

Pre‐operative OCT in idiopathic epiretinal membrane surgery: The importance of biomarkers in predicting visual outcomes

Aims/Purpose: To evaluate the influence of inner segment (IS)/outer segment (OS) junction integrity in the post‐operative visual outcomes in patients submitted to idiopathic epiretinal membrane surgery.Methods: This was a retrospective observational study that included patients who underwent plana vitrectomy with internal limiting membrane (ILM) peeling between 2017 and 2022 our centre. All patients were submitted to a complete ophthalmological observation and high‐resolution (HR) spectral domain optical coherence tomography (SD‐OCT) (Spectralis® Heidelberg) scans centred on the fovea. Best corrected visual acuity (BCVA) and OCT morphology were evaluated pre‐operatively and at 1, 3, 6 and 12 months after the surgery. Our main outcome was to understand if there was a statistical correlation between the pre‐operative IS/OS junction integrity status and post‐operative BCVA gain.Results: This retrospective study included 39 eyes from 39 patients (19 male and 20 female) with a mean age of 70.9 ± 7.8 years. Pre‐operatively, mean BCVA was 0.23 ± 0.12. Pre‐operative OCT scans revealed a mean central foveal thickness (CFT) of 549 ± 110 μm. BCVA showed a mean post‐operative improvement of 0.09 ± 0.14 at 1 month, 0.19 ± 0.17 at 3 months, 0.26 ± 0.21 at 6 months and 0.29 ± 0.23 at 12 months. There was a mean CFT reduction of 77 ± 87 μm, 129 ± 116 μm, 136 ± 121 μm and 160 ± 135 μm at 1, 3, 6 and 12 months post‐operatively. Regarding IS/OS junction status, 20 patients presented with an intact IS/OS junction and 19 patients with a disrupted or irregular junction. At 6 and 12 months post‐operatively, the correlation between visual acuity gain and IS/OS status was statistically very significant (p‐value = 0.008 and 0.002, respectively).Conclusions: IS/OS junction status in pre‐operative OCT seems to be a strong predictor of visual outcomes in patients submitted to vitreoretinal surgery for idiopathic epiretinal membrane. This biomarker should be taken into account regarding the visual prognosis of these patients.

Characteristics and response of subretinal hyperreflective material to anti-vascular endothelial growth factor in myopic choroidal neovascularization

This retrospective study evaluated the characteristics and response of subretinal hyperreflective material (SHRM) to anti-vascular endothelial growth factor (VEGF) treatment in eyes with myopic choroidal neovascularization (CNV). The visual acuity (VA) was assessed at 3, 6, and 12 months after initiating anti-VEGF treatment in 116 patients (119 eyes) with SHRM and myopic CNV. Multimodal imaging, including color fundus photography, fluorescein angiography (FA), and optical coherence tomography angiography (OCT-A), were performed. We compared type 2 neovascularization (NV) (n = 64), subretinal hyperreflective exudation (SHE) (n = 37), NV with hemorrhage (n = 15), and fibrosis (n = 3). The type 2 NV group, and NV with hemorrhage groups showed significant VA improvement after 12 months of treatment (p < 0.05 in both groups); the SHE group failed to show improvement (p = 0.366). All groups showed a significant reduction in central foveal thickness after 12 months of treatment (all p < 0.05). The SHE group had a significantly higher incidence of interrupted ellipsoid zone than the other groups (p < 0.05). Myopic CNV can present as SHRM on OCT-A. Visual prognoses vary in different SHRM types. OCT-A and FA may help predict the outcomes of different subtypes of myopic CNV. SHE is predictive of outer retinal layer atrophy in patients with various SHRM types.

Predictive impact of optical coherence tomography biomarkers in anti-vascular endothelial growth factor resistant macular edema treated with dexamethasone implant

PurposeTo perform a longitudinal analysis of the effect of optic coherence tomography (OCT) biomarkers on macular thickness in patients with persistent macular edema secondary to diabetes mellitus and retinal vein occlusion who recieved intravitreal dexamethasone (DEX) implant. MethodsEighty-nine patients were included in the retrospective study. Patients with anti-VEGF-resistant macular edema were included in the study. The effect of the presence or absence of OCT biomarkers before intravitreal DEX implant therapy on central foveal thickness (CFT) was evaluated. In addition, the change in biomarkers from the baseline visit to the final visit was evaluated. The evaluated OCT biomarkers were as follows: ellipsoid zone and external limiting membrane (ELM) integrity, hyperreflective foci (HRF), disorganization of inner retinal layers (DRIL), hard exudates, serous macular detachment (SMD), pearl necklace, posterior vitreous detachment and the epiretinal membrane (ERM). ResultsThe mean age of the overall sample in the study was 64.4 ± 9.6. CFT decreased significantly from 625.3 ± 22.3 μm at baseline to 365.0 ± 21.7 μm in the 1st month but increased significantly to 430.2 ± 22.6 μm in the 3rd month. In the presence of HRF and SMD, recurrence of macular edema was significant in the 3rd month. The percentage of ELM disruption, DRIL, and ERM deteriorated significantly and the percentage of SMD improved significantly at the final visit. ConclusionsDEX implant therapy resulted in a satisfactory reduction in CFT in patients with DME and RVO. The presence of HRF and SMD is a negative predictor of recurrence in CFT in short term. DEX implant therapy resulted in satisfactory improvement in SMD.

Comparison of intravitreal ranibizumab monotherapy vs. ranibizumab combined with dexamethasone implant for macular edema secondary to retinal vein occlusion.

PurposeTo compare the efficacy and the injection number of intravitreal ranibizumab (IVR) monotherapy vs. intravitreal ranibizumab plus dexamethasone (IVR + DEX) implants for macular edema (ME) secondary to retinal vein occlusion (RVO).MethodsThis prospective, control trial comprised 96 eyes of 96 patients with ME due to non-ischemic RVO divided into two groups. The IVR monotherapy group consisted of 61 patients (29 with CRVO and 32 with BRVO) treated with ranibizumab with three consecutive loading doses at a monthly + pro re nata (three + PRN) regimen. The IVR + DEX implant group consisted of 35 patients (19 with CRVO and 16 with BRVO) treated with intravitreal ranibizumab plus DEX implant. All eyes underwent best-corrected visual acuity (BCVA, log MAR), central foveal thickness (CFT), and intraocular pressure (IOP). In case of recurrence, each group received initial medication.ResultsAt the 12-month visit, the mean log MAR BCVA that was improved from baseline was 0.23 with the IVR group and 0.30 with the IVR + DEX group. CFT decreased on average by 420 ± 292 μm with the IVR group and 393 ± 259 μm with the IVR + DEX implant group. No significant differences were detected in BCVA improvement and CFT reduction between the two groups (p > 0.05). The mean number of injections was 5.4 in the IVR group and 3.9 in the IVR + DEX implant group (p < 0.001). The mean reinjection interval for patients with the IVR + DEX implant was 131.2 ± 8.9 days (range: 98–150). The incidence of high IOP and cataract progression were significantly higher in the IVR + DEX implant group than in the IVR group (both p < 0.001).ConclusionIn RVO-ME, the IVR + DEX implant did not have synergistic efficacy, providing further improvement in BCVA and a reduction in CFT. However, the IVR + DEX implant still had an advantage in reducing the number of injections and prolonging the time between injections.

Outcomes of Second-Line Intravitreal Anti-VEGF Switch Therapy in Radiation Retinopathy Secondary to Uveal Melanoma: Moving from Bevacizumab to Aflibercept

Introduction: Radiation retinopathy is a dose-dependent complication of the retina following exposure to ionizing radiation. The objective of this prospective case series is to determine the clinical efficacy of intravitreal aflibercept for radiation retinopathy secondary to radiotherapy for uveal melanoma in those that failed intravitreal bevacizumab treatment. Methods: A case series of 30 patients with a mean age of 57 ± 15 years with radiation retinopathy were enrolled. Visual acuity (VA) and central foveal thickness (CFT) responses to therapy were assessed with regression analyses at 1 month, 3 months, and 6 months following the switch to aflibercept. Results: Regression analyses showed a statistically significant reduction in CFT and improvements in VA following the switch to treatment by aflibercept at 1 month, 3 months, and 6 months. The mean CFT improved from 476 μm ± 170 to 386 μm ± 139 and the mean VA improved minimally from 20/115 ± 20/63 to 20/112 ± 20/54 over 6 months. After 6 months of aflibercept, 46% of patients displayed a CFT improvement of 100 μm or greater and 23% of patients showed improvement in VA of 1 line or better. Conclusion: This pilot study suggests that patients with radiation retinopathy who have failed monthly intravitreal bevacizumab may respond to aflibercept.

Treatment of chronic diabetic macular oedema with intravitreal fluocinolone acetonide implant; real-life analysis of outcomes during overall treatment period.

To assess the clinical efficacy of the fluocinolone acetonide (FA) intravitreal implant (Iluvien, Alimera Sciences) over a 12-month period in a population resistant to treatment with first-line anti-VEGF agents. This study is a retrospective cohort study assessing functional and anatomical outcomes in 13 eyes of 12 patients treated for diabetic macular oedema (DMO) with a single fluocinolone implant (FA) (Iluvien) under real-world conditions. The follow-up period includes the time of first intravitreal treatment (incl anti-VEGF or short-lasting steroids) given until 12 months post FA implant insertion. Primary outcomes were best corrected visual acuity (BCVA), measured using the modified Early Treatment Diabetic Retinopathy Study (ETDRS) grading scale, and central foveal thickness (CFT), measured using Topcon 3DOCT-2000 (Topcon Inc) SD-OCT imaging. Mean BCVA and CFT were measured before anti-VEGF treatment, after anti-VEGF treatment, at the time of Iluvien implant insertion, and 6 and 12 months after Iluvien implant insertion. The t-paired sample test was used to ascertain statistical significance of changes in comparison of two samples while the ANOVA analysis was used in comparison of three or more samples. The baseline BCVA (SD) of the cohort prior to initiation of anti-VEGF treatment was 47.45 (12.27) ETDRS letters whilst the mean CFT (SD) was 579 (203) microns. Following completion of anti-VEGF therapy, the mean improvement in vision was 8.9 ETDRS letters (p = 0.1) whilst the mean reduction in CFT was 197 microns (p = 0.028). Mean BCVA (SD) at the time of insertion of the FA implant was 55.15 (11.16) ETDRS letters and mean (SD) CFT at time of insertion of the FA was 454.62 μm (109.51). Following the 12-month treatment period with the FA implant, BCVA (SD) was 62.15 (10.25) ETDRS letters (p = 0.0331) and the mean (SD) CFT was 404.36 μm (142.92), a change of -50.26 μm from baseline (p = 0.0369). This study has shown that statistically significant improvements in BCVA and CFT can be achieved over a 12-month period with the Iluvien implant. The implant has been shown to be a safe option in the treatment of DMO and may have a role to play in achieving good functional and anatomical outcomes in DMO while also reducing the frequency of follow-up appointments required to maintain stable vision in the working-age population.

Optical coherence tomography and imaging biomarkers as outcome predictors in diabetic macular edema treated with dexamethasone implant

In this retrospective, multicenter study, we determined the predictive value of imaging biomarkers in diabetic macular edema (DME) outcomes following dexamethasone (DEX) implant(s). Sixty-seven eyes of 47 patients’ best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography (OCT) before and after intravitreal DEX implants were evaluated. Baseline imaging biomarkers were graded using fundus photography and OCT, and the predictive value of biomarkers for significant treatment effects at six months was analyzed. Six months after 2.0 ± 0.8 (mean ± SD) DEX implants, 35 (52%) and 16 (24%) eyes had CFT reduction ≥ 10% from baseline and decreased to < 300 µm, respectively. BCVA improved ≥ 3 lines in 15 (22%) and remained stable in 38 (57%) eyes. At six months, eyes with severe intraretinal cyst (IRC), abundant hyperreflective dots (HRD), and moderate or severe hard exudate had a significantly higher chance of CFT reduction ≥ 10%. Eyes with abundant HRD at baseline and those underwent three DEX implants were more likely to achieve CFT < 300 µm. Eyes with DME and severe IRC, abundant HRD, or moderate-to-severe hard exudate at baseline were more likely to show a significant reduction in CFT six months after DEX implant.

Treat-and-Extend vs. Pro Re Nata Regimen of Ranibizumab for Diabetic Macular Edema-A Two-Year Matched Comparative Study.

PurposeTo compare 2-year treatment outcomes of ranibizumab using treat-and-extend (T&E) or pro re nata (PRN) regimens for diabetic macular edema (DME) in clinical settings.MethodsWe retrospectively enrolled 34 patients (34 eyes) with DME treated with ranibizumab using the T&E regimen, and 34 patients (34 eyes) treated with ranibizumab using the PRN regimen and matched to cases in the treat-and-extend group by baseline best-corrected visual acuity (BCVA) and central foveal thickness (CFT). BCVA and CFT changes, number of injections and recurrence of macular edema over 2 years were compared between the groups.ResultsThe average BCVA gain in the T&E and PRN groups was 16.2 and 7.6 ETDRS letters at 2 years (p = 0.011), respectively. The mean CFT reduction was 145.5 ± 127.3 and 97.3 ± 152.5 μm in the T&E and PRN groups at 2 years (p = 0.035), respectively. The T&E group had a higher proportion of patients with BCVA gain ≥ 15 letters at months 18 (p = 0.015) and 24 (p = 0.029) than the PRN group. During the 2-year treatment periods, the T&E group received more injections than the PRN group (11.0 ± 3.2 vs. 6.2 ± 2.0; p < 0.001), while the PRN group had more recurrence of macular edema than the T&E group (71 vs. 41%; p = 0.015).ConclusionsAfter 2-year ranibizumab treatment for DME, better visual and anatomical improvement and less recurrence of macular edema were achieved in the T&E group, with more injections administered.

A Randomized Trial Comparing Suprachoroidal and Intravitreal Injection of Triamcinolone Acetonide in Refractory Diabetic Macular Edema due to Epiretinal Membrane.

Purpose To compare the efficacy and safety of suprachoroidal and intravitreal injection of triamcinolone acetonide in pseudophakic patients with refractory diabetic macular edema (DME) due to epiretinal membrane (ERM). Study Design. This study is a randomized clinical trial (RCT). Participants. Twenty-three nonvitrectomized pseudophakic eyes of 23 subjects (9 M and 14 F with mean age: 54.8 years) with refractory DME due to ERM. Methods The eyes were randomized to suprachoroidal triamcinolone acetonide injection 4 mg/0.1 ml (SCTA) (n = 13 eyes) or intravitreal triamcinolone acetonide 4 mg/0.1 ml (IVTA) (n = 10 eyes) and were evaluated at baseline and 1 and 3 months after injection to assess outcome measures. Main Outcome Measures. Changes in best-corrected visual acuity (BCVA) (primary outcome), central foveal thickness (CFT) by optical coherence tomography (OCT), and intraocular pressure (IOP) measurement (secondary). Results Baseline median BCVA (logMAR) was 1.0 (range 0.8–1.0) in both groups, improved within the SCTA group to 0.8 on the 1st and 3rd months, while in the IVTA group, median BCVA changed to 0.8 and 0.9 on the 1st and 3rd months, respectively. No significant differences were noted between groups regarding BCVA at baseline (P=0.927), and 1st (P=0.605) and 3rd months (P=0.313). Regarding mean CFT, no significant differences were observed at baseline (P=0.353) and at the first month (P=0.214) between both groups, while at the third month, CFT was significantly higher in the IVTA group (385 um) than in the SCTA group (323 um) (P=0.028). Mean IOP was significantly higher in the IVTA group (15 mmHg) on 1st month than in the SCTA group (12 mmHg) (P=0.011); after 3rd month, IOP was significantly higher within the IVTA group (18 mmHg) than SCTA (14 mmHg) (P=0.028). No significant difference was noted between both groups at baseline IOP (P=0.435). Conclusions Both SCTA and IVTA are effective in reduction of CFT and improvement of patients' visual acuity, but with a higher recurrence rate and rise in IOP after IVTA when compared to SCTA. Both treatments have temporary effects with the possibility of recurrence of DME and the need for retreatment.

Nondamaging retinal laser therapy in recurrent diabetic macular edema after antiVEGF injections.

Subthreshold yellow nondamaging retinal laser therapy (NRT) could provide a greater safety profile when compared to conventional laser methods. NRT may also improve diabetic macular edema (DME). This study aims to assess whether the severity of DME affects the efficacy of subthreshold yellow NRT. The study included 70 eyes that had previously been treated with ranibizumab for DME and then developed recurrent macular edema, which was treated with NRT once. The central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were evaluated retrospectively 2 months following the NRT. The eyes in the study were divided into 4 different groups according to the baseline CFT values. The initial CFT was 250-300 μm in Group 1 (n = 26), 301-400 μm in Group 2 (n = 24), and >401 μm in Group 3 (n = 20). Group 4 (n = 20) included control subjects with 250-300 µm CFT, diagnosed with DME, and not previously treated. The alterations in the BCVA and CFT were measured. In the study, it was determined that 45 right eyes and 45 left eyes were involved. Statistically significant decrements (42.84 m reduction) in CFT were detected only in the Group 1 (p = 0.01). There was no significant improvement in CFT within Group 2, 3 and 4 (p = 0.29, p = 0.73, p = 0.22, respectively). Solely Group 1 had statistically significant improvement (from 0.54 to 0.39 LogMAR) in BCVA (p = 0.01), while groups 2, 3 and 4 had no improvement at all (p = 0.74, p = 0.96, p = 0.66 respectively). Based on the results, NRT provided an improvement in BCVA and CFT in eyes with CFT less than 300 µm at the shortterm follow-up. However, CFT and BCVA outcomes after NRT were inferior to those achieved after previous ranibizumab treatment. No positive effect of NRT was not observed in patients with moderate and severe macular edema in DME treatment.

Review on Surgical Management of Diabetic Macular Edema

Literature review for surgical management for both tractional and non-tractional diabetic macular edema; with and without internal limiting membrane peeling. According to the DRCR prospective study, traction relaxation allowed vision gain and reduction in central foveal thickness in tractional diabetic macular edema. Also data from small scale and pilot studies about the role of pars plana vitrectomy for non-tractional CI-DME management, showed visual gain and edema resolution in both naive and refractory cases. It is concluded that pars plana vitrectomy has a role the management of DME; however, large scale trials are needed to define the role, optimum timing, and patients characteristics for the usage of vitrectomy in non-tractional DME management.

Assessment of efficacy and safety of intravitreal ranibizumab in patients with macular edema secondary to retinal vein occlusion

The aim of the study was to assess the efficacy and safety of individualized repeated injection of intravitreal anti-VEGF ranibizumab for preserving or improving vision (BCVA) and central foveal thickness (CFT) in macular edema secondary to retinal vein occlusion (RVO).25 eyes of 25 patients with RVO were included. General and systemic examination was done. IOP measurement, slit lamp, fundus examination, BCVA assessment and OCT was done. CFT was measured to assess macular edema. Injection intravitreal ranibizumab (0.5mg/0.05ml) was given in the affected eye, every 6 weeks, till week 18, if CFT&amp;#62;250 µm. Total 3 injections were given in each patient. Final follow-up visit was at week 36.Hypertension (72%), DM (20%) and altered lipid profile (16%) were associated comorbidities. There was significant reduction in mean CFT from baseline visit (516.08±35.21) to week 18 visit (203.32±4.97) with P&amp;#60;0.0001. There was no significant statistical difference between week 18 CFT and week 36 CFT (P=0.44). There was significant reduction in mean CFT from baseline visit (516.08±35.21) to week 36(251.60±23.17) with P&amp;#60;0.0001.There was significant improvement in mean BCVA from baseline visit (0.87±0.03) to week 18 visit (0.27±0.03). There was no significant statistical difference between week 18 BCVA and week 36 BCVA (P=0.76). There was a significant reduction in mean BCVA from baseline visit (0.87±0.03) to week 36(0.35±0.05) with P&amp;#60;0.0001.At week 36 follow up visit, 4 patients had recurrence of macular edema. 2 had uncontrolled hypertension, 2 had combined uncontrolled hypertension and DM. 21(84%) patients had stable CFT and BCVA. No significant ocular or systemic side-effects were seen.Individualized repeated intravitreal injection of ranibizumab showed improvement in BCVA and CFT in patients with macular edema secondary to RVO. For long term maintenance, control of systemic comorbidities is essential.

Surgical effects of internal limiting membrane peeling with vitrectomy for vitreo-macular traction in diabetic patients

Aim: To evaluate the surgical effects of internal limiting membrane (ILM) peeling with parsplana vitrectomy in diffuse diabetic macular edema with vitreo-macular traction as regard the best corrected visual acuity, central foveal thickness, residual epiretinal membrane and recurrent traction. Methods: The study included twenty eyes of twenty patients with diffuse diabetic macular edema and vitreo-macular traction. Seven eyes underwent vitrectomy with ILM peeling (group I) and thirteen eyes underwent vitrectomy without ILM (group II). The inclusion criteria were diffuse diabetic macular edema with optical coherence tomography evidence of vitreo-macular traction with or without epiretinal membrane. Exclusion criteria involved any ocular disease can cause macular edema rather than diabetes mellitus and eyes with macular ischemia. The effect of ILM peeling was evaluated on the surgical outcomes as regard best corrected visual acuity, central foveal thickness, residual epiretinal membrane and recurrent traction at postoperative one, three and six months. Results: Statistically significant improvement of best corrected visual acuity and reduction of central foveal thickness occurred in all eyes postoperatively and over time with statistically insignificant difference between both groups. No eyes in group I and eight eyes in group II showed residual epiretinal membrane with a statistically significant difference between both groups. No eyes in group I and two eyes in group II showed recurrent traction due to residual epiretinal membrane with a statistically insignificant difference between both groups. Conclusion: ILM peeling has an important role in complete removal of epiretinal membrane and prevention of recurrent traction.

Efficacy Of Macular Photocoagulation When Given In The Early Or Late Period After Single Intravitreal Bevacizumab Injection In Terms Of Central Foveal Thickness Change And Visual Acuity Gain

AIM: To find out the efficacy of macular photocoagulation when given in the early or late period after single intravitreal bevacizumab injection in terms of central foveal thickness change and visual acuity gain.METHODS:40 patient eyes were studied and they were divided into groups based on sex, age, hba1c levels, severity of disease and treatment received over the period of 6months.RESULT: patients receiving deferred macular photocoagulation after a single intravitreal injection of bevacizumab had better outcomes regarding reduction of central foveal thickness and improvement in visual acuity at the end of 6-month observation period compared to those patients receiving prompt macular photocoagulation.

Intravitreal conbercept for branch retinal vein occlusion induced macular edema: one initial injection versus three monthly injections

BackgroundTo compare the efficacy of one initial intravitreal injection of conbercept (IVC) versus three monthly IVCs in patients with macular edema (ME) after branch retinal vein occlusion (BRVO). Both options were followed by a pro re nata (PRN) retreatment regimen.MethodsThis study retrospectively investigated and followed 60 patients with acute ME secondary to BRVO for over a year. 30 subjects received one initial injection (1 + PRN group); while, 30 received three monthly injections (3 + PRN group). The functional and anatomic outcomes were assessed during each follow-up.ResultsThe general characteristics of the 60 subjects were as follows: mean [SD] age, 57.43 [13.06] years; 33 [55%] female; 36 [60%] non-ischemic form. Both groups showed a stable gain in visual acuity (VA) with similar logMAR (mean ± SD) (1 + PRN group 0.308 ± 0.399, 3 + PRN group 0.34 ± 0.352) during the first 12 months. Additionally, both groups exhibited a significant reduction in central foveal thickness (CFT) with no statistically significant difference between them (1 + PRN group 222.1 μm ± 197.1 μm, 3 + PRN group 228.4 μm ± 200.2 μm). Both treatment groups had similar improvements in logMAR and anatomic outcomes over time. The stratified analysis showed that patients with the non-ischemic form and those with the ischemic form had similar improvements in VA (0.346 ± 0.366 VS 0.29 ± 0.39, P = 0.575) during the 12 months follow-ups. The number of injections was lower in the 1 + PRN group (4.0 ± 1.6) than in the 3 + PRN group (4.7 ± 1.3) (P = 0.068). No adverse effects or unexpected safety issues were reported in either group.ConclusionsConbercept yielded significant improvements in VA and CFT among patients with BRVO induced ME, independent of their retinal ischemia status. The results showed that the 3 + PRN regimen do not lead to better functional outcomes or lower treatment needs in clinical practice as compared to the 1 + PRN regimen.

THE EFFECT OF AGE ON AFLIBERCEPT (EYLEA) RESPONSE IN DIABETIC MACULAR EDEMA.

To investigate the effect of age on aflibercept (Eylea) response in macular edema secondary to treatment-naive diabetic eyes. Two hundred seventy-three eyes of 273 treatment-naive patients with macular edema secondary to diabetes mellitus were enrolled in this study. The patients in the study were divided into the following 4 groups according to their ages: Group 1 (40-50 years), Group 2 (51-60 years), Group 3 (61-70 years), and Group 4 (>70 years). Three consecutive injections at intervals of 1 month were applied to all diabetic patients. The efficacy of the aflibercept treatment on macular edema according to age groups was assessed by optical coherence tomography by comparing the central foveal thickness (CFT) values and mean visual acuity changes after initial and three loading dose injections. After three consecutive aflibercept injections, the mean reduction of CFT in Groups 1, 2, 3, and 4 were -256.4 ± 110.9, -197.4 ± 96.4, -189.4 ± 110.8, and -186.2 ± 118.9 µm, respectively. The changes of CFT was significantly different between age groups (P = 0.003, analysis of covariance). The improvement of visual acuity was significantly different in each group (P < 0.001 in all groups, paired-samples t-test), and changes of visual acuity was significantly different between age groups (P < 0.05, analysis of covariance). In addition, ages of patients were correlated with the mean reduction of CFT and mean improvement of visual acuity for the whole study group (r = -0.183, P = 0.002 for CFT; r = -0.682, P < 0.001 for visual acuity, Pearson correlation). In this study, it was observed that the efficacy of aflibercept treatment was found to be more effective in younger patients in treatment-naive diabetic macular edema patients.

Retinal thickness fluctuations in patients receiving fluocinolone acetonide implant for diabetic macular edema

Objectives To evaluate central foveal thickness (CFT) variability and accompanying changes in visual acuity (VA) 12 months before and after treatment with the 190 mcg fluocinolone acetonide (FAc) intravitreal implant for diabetic macular edema (DME). Methods The Iluvien Clinical Evidence cohort study in the United Kingdom (ICE-UK) investigated the effectiveness of the FAc implant in people treated at 13 hospitals from April 2013 to April 2015. The following parameters were calculated for CFT for each patient: mean, standard deviation (SD), retinal thickness amplitude (RTA, the difference between maximum and minimum values), and coefficient of variation (CV). Results In 149 eyes with ≥2 CFT observations both before and after FAc implantation, the median VA was 50 ETDRS letters at implantation. Mean CFT was 487 µm at implantation and 135 µm at 12 months post-implant. Before implantation, the mean CV and mean SD for CFT were 24.6% and 112 µm, respectively; the mean RTA was 254 µm. A statistically significant (p < .001) decrease in all three parameters was observed after implantation (18.3%, 68.2 μm and 146 μm, respectively). There was an association between CFT change between extremes and the corresponding change in VA (Pearson’s correlation coefficient, r = −0.292, p < .001, prior to the implant; r = −0.379, p < .001, post-implant). Conclusions After accounting for the reduction in CFT, retinal thickness stabilized following FAc implantation. There might be VA benefits in reducing variability in CFT over time. This merits further exploration but would require more frequent CFT observations in order to properly determine patterns of retinal thickness variability.

The efficacy of selective retina therapy for diabetic macular edema based on pretreatment central foveal thickness.

To evaluate the efficacy of selective retina therapy (SRT) in patients with diabetic macular edema (DME) based on pretreatment central foveal thickness (CFT). Seventy-two eyes of 63 patients with DME who had previously undergone SRT were included. Patients were divided into two groups based on the CFT at baseline. Group 1 was composed of 35 eyes with CFT < 400μm and group 2 was composed of 37 eyes with CFT ≥ 400μm. Changes in best corrected visual acuity (BCVA) and CFT were measured at baseline, 3 and 6months after SRT. A single-session retreatment was performed at 3-month posttreatment if there was no reduction in CFT. Rescue treatment with intravitreal anti-VEGF injections was performed if persistent DME or vision loss of 1 ≥ logMAR VA line was observed by 6months after initial SRT. Six months after SRT, group 1 showed reduction of 45.9μm in mean CFT (P < 0.001) and gain of 0.13 logMAR in mean BCVA (P < 0.001), whereas group 2 experienced no significant change in CFT or BCVA. In group 1, retreatments were performed in 6 eyes (17.1%), and rescue treatment was performed in 1 eye (2.9%), whereas in group 2, retreatment was performed in 17 eyes (45.9%), and rescue treatments were administered in 27 eyes (73%) during a 6-month follow-up. Although SRT had limited effects as a treatment for severe DME, SRT monotherapy for mild DME was effective in improving BCVA and reducing CFT during a 6-month follow-up period.