Ahmed Glaucoma Valve Implantation in Vitrectomized Eyes

Purpose. To evaluate the outcomes of Ahmed glaucoma valve (AGV) implantation in vitrectomized eyes. Materials and Methods. The medical records of 13 eyes that developed glaucoma due to emulsified silicon oil or neovascularization following pars plana vitrectomy and underwent AGV implantation were retrospectively reviewed. The main outcome measures were intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of antiglaucoma medications, and postoperative complications. Surgical success was defined as last IOP ≤21 mmHg or ≥6 mmHg and without loss of light perception. Results. The mean follow-up duration was 11.7 ± 5.5 (range, 6–23) months. The mean IOP before the AGV implantation was 37.9 ± 6.7 mmHg with an average of 3.5 ± 1.2 drugs. At the final visit, the mean IOP was 15.9 ± 4.6 mmHg (p=0.001) and the mean number of glaucoma medications decreased to 2.3 ± 1.3 (p=0.021). At the last visit, 11 eyes (84.4%) had stable or improved VA and one eye (7.7%) had a final VA of no light perception. Surgical success was achieved in 11 of the 13 eyes (84.4%). Postoperative complications were bleb encapsulation (69.2%), early hypotony (38.5%), hyphema (23.1%), decompression retinopathy (23.1%), choroidal detachment (15.4%), intraocular hemorrhage (7.7%), and late endophthalmitis (7.7%). One eye (7.7%) was enucleated because of late endophthalmitis. Conclusions. Despite complications necessitating medical and surgical interventions, vitrectomized eyes were effectively managed with AGV implantation

Comparison of the Results of Secondary Anterior Chamber and Secondary Scleral-Fixated Intraocular Lens Implantation in Complicated Phacoemulsification Cases

Objectives: To compare the visual prognosis and postoperative complication rates of secondary anterior chamber (AC IOL) and scleralfixated (SF) intraocular lenses (IOL) after complicated phacoemulsification surgery. Materials and Methods: Thirty eyes of thirty patients were reviewed for this retrospective study. The patients with secondary AC IOL implantation formed group 1 (n=15), and the patients with secondary SF IOL implantation formed group 2 (n=15). Best-corrected visual acuity (BCVA) with Snellen chart, biomicroscopic examination, intraocular pressure (IOP) measurement with applanation tonometer, gonioscopy performed by Goldmann’s 3-mirror contact lens, and fundus examination were performed preoperatively in all patients. Results: There was no statistically significant difference in postoperative BCVA (p=0.492) and postoperative success (BCVA not changed or better postoperatively) between the 2 groups (p=0.598). Postoperative success rate was 80% in group 1 and 93.7% in Group 2. The postoperative cylindrical power of the eyes did not differ significantly between the groups (p=0.220). The postoperative complications in group 1 were as follows: transient corneal edema in 5 eyes, transient IOP elevation in 2 eyes, postoperative fibrinous reaction in the anterior chamber in one eye, late-onset secondary glaucoma in one eye, hyphema in one eye, cystoid macular edema in one eye, vitreous prolapse into the anterior chamber in one eye, and IOL malposition in one eye. The postoperative complications in group 2 were as follows: transient corneal edema in 3 eyes, vitreous prolapse into the anterior chamber in 2 eyes, IOL malposition in 2 eyes, transient IOP elevation in one eye, and retinal detachment in one eye. Conclusion: In this study, both IOL types were observed to be preferable in cases without adequate capsular support following complicated cataract surgery. However, further studies with large numbers of patients are needed to define the best choice of IOL in patients with inadequate capsular support. (Turk J Ophthalmol 2014; 44: 102-7

Comparison of The Effi ciency of Intravitreal Dexamethasone Implant and Ranibizumab in The Treatment of Macular Edema Secondary to Branch Retinal Vein Occlusion: 6 Months Results

Amaç: Retina ven dal tıkanıklıklarına (RVDT) bağlı makula ödemi tedavisinde intravitreal deksametazon implantı ve ranibizumab enjeksiyonunun 6. aydaki etkinliğini karşılaştırmak.Gereç ve Yöntem: Retina ven dal tıkanıklığına bağlı makula ödemi gelişen 61 hastanın gözü geriye dönük olarak incelendi. Yirmi dokuz (grup 1) hastaya 0.7 mg tek doz intravitreal deksametazon implantı ve 32 hastaya (grup 2) pro re nata (PRN) olarak 0.5 mg ranibizumab enjeksiyonu yapıldı. Enjeksiyon öncesi ve sonrası 6. aydaki en iyi düzeltilmiş görme keskinlikleri (EİDGK) ve santral makula kalınlıkları (SMK) kaydedildi. Her iki grup etkinlik açısından karşılaştırıldı. Bulgular: Grup 1' e tek doz deksametazon implant, grup 2' ye ortalama 2.38±0.87 ranibizumab enjeksiyonu yapıldı. Grup 1' in uygulama öncesi ve 6. ay ortalama EİDGK sırasıyla 1.0828±0.60419 ve 0.7566±0.53714 logarithm of the minimum angle of resolution (logMAR), grup 2' nin ise 0.9891±0.50477 ve 0.5781±0.41241 logMAR idi. Ortalama SMK uygulama öncesi ve 6. ayda grup 1' de 516.48±145.890 ?m ve 428.69±148.497 ?m, grup 2' de 535.78±106.653 ?m ve 358.94±115.860 ?m idi. Altıncı ayda her iki grupta EİDGK artışı ve SMK da azalma izlendi (p<0.05). Ancak grup 2' nin SMK 'sı grup 1' den anlamlı olarak düşük bulundu (p<0.05). Sonuç: Retina ven dal tıkanıklığına bağlı makula ödemi tedavisinde intravitreal deksametazon implant ve ranibizumab enjeksiyonunun etkinlikleri benzer bulundu. Ancak 6. ayda ranibizumabın SMK'daki azalma üzerine etkisinin deksametazon implantına göre daha fazla olduğu gözlendi.Purpose: To compare the effi ciency of intravitreal dexamethasone implant and ranibizumab in the treatment of macular edema secondary to branch retinal vein occlusion at month 6.Methods: Sixty one eyes of 61 patients with macular edema secondary to branch retinal vein occlusion were evaluated retrospectively. Twenty-nine patients (group 1) received 0.7 mg single dose intravitreal dexamethasone implant and 32 patients (group 2) received 0.5 mg PRN ranibizumab injection. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded at baseline and 6 th month of injection. Both groups were compared by means of effi cieny. Results: Group 1 received single dose intravitreal dexamethasone implant and group 2 received mean 2.38&plusmn;0.87 ranibizumab injections. Mean BCVA at baseline and month 6 was 1.0828&plusmn;0.60419 and 0.7566&plusmn;0.53714 logarithm of the minimum angle of resolution (logMAR) in group 1; 0.9891&plusmn;0.50477 and 0.5781&plusmn;0.41241 logMAR in group 2, respectively. Mean CMT at baseline and month 6 was 516.48&plusmn;145.890 ?m and 428.69&plusmn;148.497 ?m in group 1; 535.78&plusmn;106.653 ?m and 358.94&plusmn;115.860 ?m in group 2, respectively. There was an increase in BCVA and reduction in CMT in both groups at month 6 (p&lt;0.05). But CMT in group 2 was signifi cantly less than group1 (p&lt;0.05). Conclusion: Both intravitreal dexamethasone implant and ranibizumab injection effi cacy was found to be similar in the treatment of macular edema secondary to branch retinal vein occlusion. However, at month 6, ranibizumab appeared to have a greater effect on central macular thickness reduction compared to intravitreal dexamethasone implant

An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study

Purpose: To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR). Methods: This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11 months but was extended in a minority of cases up to 7 years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement. Results: One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1 month) was favoured by age 500 μm (p = 0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1 month was favoured by first episode (p = 0.04), height of subretinal fluid >500 μm (p < 0.0001) and short duration of observation (p = 0.02). Finally, there was no statistically significant difference among the treatments at 12 months. Conclusion: Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification