Posterior sub-tenon's bevacizumab injection in diabetic macular edema; a pilot study

Purpose: To evaluate the short-term results of sub-tenon's injection of bevacizumab in patients with clinically significant macular edema (CSME). Methods: In this prospective non-comparative interventional case series, sub-tenon's injection of 2.5. mg/0.1. ml bevacizumab was performed for eyes with CSME. Macular thickness and best corrected visual acuity measurements were performed before and one month after injections. Results: Nineteen eyes of twelve patients with a mean age of 59.8. ±. 5.7. years were evaluated. Thirteen eyes (68.4) had center-involving macular edema. No significant difference was observed between pre- and post-injection central subfield retinal thickness measurements (P= 0.3). Central subfield thickness measurements improved or remained unchanged in 13 eyes (68.4). Baseline BCVA of 0.48. ±. 0.35 LogMAR improved to 0.36. ±. 0.26 LogMAR after injection (P= 0.01). Improvement of. > 2 lines in BCVA was found in 5 eyes (26.3), and no eye lost. > 2 lines of BCVA. No complication associated with sub-tenon's injection was observed. Conclusion: Sub-tenon's injection of bevacizumab resulted in significant short-term visual improvement in eyes with CSME. Retinal thickness changes were not significant. © 2015 The Authors

Macular thickness measurement in clinically significant macular edema before and after meal

Purpose: To evaluate the macular thickness changes in diabetic macular edema after meal. Methods: In this prospective case series, macular thicknesses of diabetic patients with clinically significant macular edema (CSME) were measured after 7 h of fasting and repeated 2 h after breakfast. Results: Thirty six eyes of 20 diabetic patients were evaluated. The mean central subfield thickness (CST) and maximum retinal thickness (MRT) significantly decreased after meal (mean change of -10.3 ± 14.3 μm and -13.1 ± 12.7 μm, respectively, both P < 0.001). A decrease in CST and MRT values was found in 23 (63.8) and 28 (77.7) eyes, respectively, and no eye had an increase in retinal thickness measurements. Significant correlation was found between CST and MRT change and fasting thickness measurements (P = 0.001 and P = 0.01, respectively) and intraretinal cystic spaces (P = 0.001 and P = 0.03, respectively). Mean MRT change was significantly higher in the presence of subretinal fluid (P = 0.01). Conclusion: Retinal thickness measurements may change after meal. So, fasting state of diabetic patient should be considered in measurement of macular thickness of patients with CSME. © 2015 Iranian Society of Ophthalmology

Ultra-wide-field imaging in diabetic retinopathy; an overview

Purpose: To present an overview on ultra-wide-field imaging in diabetic retinopathy. Methods: A comprehensive search of the pubmed database was performed using the search terms of "ultra-wide-field imaging", "ultra-wide-field fluorescein angiography" and "diabetic retinopathy". The relevant original articles were reviewed. Results: New advances in ultra-wide-field imaging allow for precise measurements of the peripheral retinal lesions. A consistent finding amongst these articles was that ultra-wide-field imaging improved detection of peripheral lesion. There was discordance among the studies, however, on the correlation between peripheral diabetic lesions and diabetic macular edema. Conclusions: Visualization of the peripheral retina using ultra-wide-field imaging improves diagnosis and classification of diabetic retinopathy. Additional studies are needed to better define the association of peripheral diabetic lesions with diabetic macular edema. © 2016 Iranian Society of Ophthalmology

Correlation between cystatin-C, acute phase reactants, and retinopathy severity in diabetic patients

AIM: To evaluate correlation of cystatin-C (Cys-C) with severity of diabetic retinopathy (DR) and acute phase reactants, including erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hs-CRP). METHODS: All diabetic patients who were referred for diabetic retinopathy (DR) screening during 1mo were enrolled. Demographic data were recorded. All patients have undergone full ophthalmic exam. At the same day, all patients were tested for hemoglobin A1c (HbA1c), ESR, hs-CRP, and Cys-C serum levels. RESULTS: Sixty seven diabetics were enrolled, including 19 (28.3) without retinopathy, 22 (32.8) non-proliferative retinopathy, and 26 (38.8) proliferative retinopathy patients. The mean age, sex distribution, mean duration of diabetes, prevalence of hypertension and dyslipidemia, smoking status and HbA1c levels were not significantly different among the three groups. The mean levels of Cys-C increase significantly as retinopathy progress $$1.1±0.48; 1.22±0.38; 1.71±0.92 (P=0.007), respectively$$. In multiple regression analysis, just Cys-C was significantly associated with severity of DR (P=0.025). CONCLUSIONS: This study revealed that serum levels of Cys-C increase while DR progress independently of acute phase reactants. Therefore, it could be used as an associated marker by primary care physicians to distinguish patients at higher risk of severe DR. Larger randomized studies are warranted to confirm findings. Reviewing physiological role of the Cys-C, we proposed that the Cys-C may be a protective response to catalytic stress rather than being a pathogenic factor in microangiopathies. Copyright 2018 by the IJO Press

Refractive outcomes following the treatment of retinopathy of prematurity in the anti-VEGF era: a literature review

A growing body of evidence indicates that antivascular endothelial growth factor (VEGF) therapy is effective in the treatment of retinopathy of prematurity (ROP). We conducted a comprehensive literature review on refractive outcomes of anti-VEGF treatments compared to laser treatment or a combination of laser therapy and anti-VEGF injections. Of the 9 studies analyzed, the final mean refractive error was myopic in 3 studies (37) with IVB monotherapy, 7 studies (87.5) with laser photocoagulation, and 1 study (50) with combined therapy. In comparing IVB with laser monotherapy, 6 of 7 studies (86) reported that final refractive error was significantly more myopic (>1 D) after laser treatment. No study was graded as high quality, and only a single article provided moderate quality of evidence. © 2016 American Association for Pediatric Ophthalmology and Strabismu

Comparison between 90-degree and 360-degree selective laser trabeculoplasty (SLT): A 2-year follow-up

Purpose: To compare the effect of 90- and 360-degree selective laser trabeculoplasty (SLT) as primary or supplement therapy in patients with glaucoma and ocular hypertension (OHT). Methods: Patients (>30 years old) with OHT, primary open-angle glaucoma (OAG), pigmentary glaucoma or pseudoexfoliative glaucoma were enrolled in a prospective randomized clinical trial. Patients were sequentially randomized to either 90- or 360-degree SLT. Their intraocular pressure (IOP) was monitored. Results: The survival periods (in days) of the two extents (90 or 360 degrees) of treatment were not statistically significantly different (p = 0.85); only pretreatment IOP level could predict survival of treatment (p = 0.02). Conclusion: The 90-degree SLT is as effective as 360-degree SLT. Further studies are warranted to confirm the findings. High baseline IOP could be a factor that predicts treatment success. © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Lt