Improvement of visual acuity based on optical coherence tomography patterns following intravitreal bevacizumab treatment in patients with diabetic macular edema

<b>AIM:</b>To report the visual outcome based on various patterns of optical coherence tomography (OCT) morphology in diabetic macular edema (DME), following treatment with anti-VEGF intravitreal bevacizumab (IVB) injection.<b>METHODS:</b>Sixty-seven consecutive subjects with centre involving DME underwent intravitreal injection of Bevacizumab (1.25 mg/0.05 mL) in this retrospective, comparative, non randomized study. The DME was classified into one of four categories:focal, diffuse, focal cystoid and neurosensory detachment based on OCT. Best corrected visual acuity (BCVA), macular appearance, and OCT findings were used to decide whether the subject should have a repeat injection of intravitreal bevacizumab. Outcome measures were a change in mean BCVA (Snellen converted to logMAR) and central macular thickness (CMT) in each group during the six month follow-up period.<b>RESULTS:</b>The mean BCVA improved to logMAR 0.23 at final follow-up from a baseline of 0.32 logMAR (<i>P=</i>0.040) in the focal group, logMAR 0.80 at final follow-up from a baseline of 0.82 logMAR (<i>P=</i>0.838) in the diffuse group, worsened to logMAR 0.53 at final follow-up from a baseline of 0.43 logMAR (<i>P=</i>0.276) in the focal cystoid group, and improved to logMAR 0.79 at final follow-up from a baseline of 0.93 logMAR (<i>P=</i>0.490) in the neurosensory detachment group. The mean CMT before treatment were 298.8±25.03 μm in the focal group, 310.8±40.6 μm in the diffuse group, 397.15±31.05 μm in the focal cystoid group and 401.03±75.1 μm in the neurosensory detachment group. A mean of 2.05 (range:1-5) injections in the focal group, 1.32 (range:1-2) in the diffuse group, 2.6 (range:1-6) in the focal cystoid group and 2.6 (range:1-6) in the neurosensory detachment group were performed during the six month follow-up period. Following intravitreal bevacizumab treatment, vision improved, remained unchanged or worsened in 11, 7 and 2 subjects in focal group; 11, 9 and 8 in diffuse group; 0, 2 and 4 in focal cystoid group and 5, 5 and 3 subjects respectively in neurosensory detachment group.<b>CONCLUSION:</b>OCT morpholgy patterns in DME may predict the effects of intravitreal bevacizumab treatment, and patients with focal DME are most likely to benefit from the improvent of visual acuity from this treatment

A review of the efficacy of mitomycin C in glaucoma filtration surgery

The success of trabeculectomy, which is considered the gold standard in the surgical treatment of glaucoma, depends on the wound healing response. The introduction of antiproliferative agents such as mitomycin C (MMC) has increased the success rates of trabeculectomy. However, complications due to these agents can be challenging to manage. Hence, it is important to determine the most efficacious dose and duration of exposure. Multiple studies suggest that many factors, including but not limited to MMC preparation, different concentrations, different exposure times, and method of application may affect success rate, and these factors were reviewed in this article. We concluded that lower concentrations of MMC that are prepared and applied in a standardized fashion, such as that using the Mitosol(®) kit (for 2–3 minutes) during trabeculectomy, could potentially provide trabeculectomy success rates similar to that reported with off-label preparations, and that such a treatment regime could result in in lower complication rates than higher doses of MMC

Long Term Outcome of Combined Phacoemulsification and Excisional Goniotomy with the Kahook Dual Blade in Different Subtypes of Glaucoma

Abstract Purpose: To characterize changes in intraocular pressure (IOP), IOP-lowering medications, and visual acuity (VA) through 3 years of follow-up in patients undergoing combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (phaco-KDB), with simultaneous goniosynechialysis in cases of angle-closure glaucoma, by a single surgeon (A.H.) in King Fahd Hospital of the University, Dammam, Saudi Arabia.Methods: Prospective, non-comparative, uncontrolled, non-randomized interventional case series. Consecutive patients with medically-treated glaucoma and visually-significant cataract underwent combined surgery. Subgroup analysis of glaucoma subtypes was performed.Results: Fifty-seven eyes (48 patients) including 29 eyes with primary open-angle glaucoma, 15 with pseudoexfoliation glaucoma, and 13 with angle-closure glaucoma, were enrolled. Mean (standard error) baseline IOP was 20.3 (0.7) mmHg and through up to 36 months of follow-up (minimum 12 months, mean 26.2 [1.0] months) ranged from 13.5-14.0 mmHg (13.7 mmHg at Month 36); significant reductions (p&lt;0.0002) of 23.6-29.9% were achieved at every time point. Medications were reduced from a mean of 3.3 (0.1) to 0.2-1.9 (reduction 51.4-94.7%; p&lt;0.0001 at every time point). Mean logMAR VA improved from 0.97 (0.11) preoperatively to 0.25 (0.04) by Month 6 (p&lt;0.0001), remaining stable thereafter. Outcomes were similar in POAG, pseudoexfoliation, and ACG subgroups. Hyphema occurred and resolved spontaneously in 6 eyes; 1 eye had elevated IOP on postoperative day 1.Conclusions: Phaco-KDB significantly improved VA, lowered IOP ~25-30%, and lowered medications by &gt;50% through 36 months. This combined procedure provides meaningful long-term reductions in IOP and need for IOP-lowering medication without compromising visual rehabilitation in eyes with cataract and glaucoma.</jats:p

Long term outcome of combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade in different subtypes of glaucoma

AbstractTo characterize changes in intraocular pressure (IOP) and IOP-lowering medications through up to 2 years of follow-up in patients undergoing combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (phaco-KDB), with simultaneous goniosynechialysis in cases of angle-closure glaucoma. Prospective, non-comparative, interventional case series. Consecutive patients with medically-treated glaucoma and visually-significant cataract underwent combined surgery. Analysis was conducted on open-angle (OAG) and angle-closure (ACG) glaucoma groups separately. Thirty-seven patients with OAG (24 with primary OAG and 13 with pseudoexfoliation glaucoma) and 11 with ACG were enrolled. In OAG eyes, mean (standard error) baseline IOP was 21.1 (0.9) mmHg and through 24 months of follow-up was reduced by 6.4–7.7 mmHg (24.6–32.1%; p ≤ 0.0001 at all time points). In ACG eyes, mean baseline IOP was 20.8 (1.6) mmHg and was reduced by 6.1–8.77 mmHg (23.4–39.0%; p ≤ 0.0353). Mean medications were reduced by 61.9–89.1% (p ≤ 0.0001) in OAG eyes and by 56.3–87.3% (p ≤ 0.0004) in ACG eyes. Phaco-KDB significantly lowered IOP ~ 30% and medications by &gt; 50% through 24 months. This combined procedure provides meaningful long-term reductions in IOP and need for IOP-lowering medication and does not adversely affect visual rehabilitation in eyes with cataract and glaucoma.</jats:p

Presentation of acute central retinal vein occlusion in scleroderma

AbstractCentral retinal vein occlusion (CRVO) is a rare complication of scleroderma. Here we report a case of a 30-year-old man who was diagnosed to have scleroderma in the rheumatology and dermatology clinic. During treatment with systemic steroids and immunosuppressive therapy the patient developed a sudden decrease of vision in the right eye and was diagnosed to have right CRVO with macular edema on fundus examination. After three consecutive Intravitreal bevacizumab (IVB) injections for macular edema, best-corrected visual acuity (BCVA) improved from 20/80 to 20/25. All ocular and systemic causes of CRVO other than scleroderma were excluded in our patient by thorough clinical examination and investigations, suggesting that scleroderma was the most possible etiology in his condition