Comparison of one and three initial monthly intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion

AIM: To compare three initial monthly intravitreal ranibizumab (IVR) injections followed by pro re nata (PRN) dosing with one initial monthly IVR injections followed by PRN dosing for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Forty-two eyes of 42 patients who had IVR injections for BRVO were retrospectively studied. Eighteen eyes received 1 initial IVR injection (1+PRN group) and 24 eyes received 3 monthly IVR injections (3+PRN). At 1, 3, 6 and 12mo; spectral-domain optical coherence tomography (SD-OCT) was performed. Central macular thickness (CMT), the integrity of the external limiting membrane (ELM), the presence of subretinal fluid, cyst size, the presence of inner segment/outer segment (IS/OS) defect were determined. RESULTS: At baseline the mean CMT was 521.3±153.2 µm in the 3+PRN group while it was 438.1±162.4 µm in 1+PRN group. At the final visit, mean CMT was 278.3±87.8 µm in the 3+PRN group and 285.2±74.2 µm in the 1+PRN group (P=0.079). The changes in CMT over the entire study period were also comparable in both groups (243±160 µm in the 3+PRN group, and 152.9±175.3 µm in the 1+PRN group; P=0.090). At baseline, best-corrected visual acuity (BCVA) was 0.92±0.60 logarithm of the minimal angle of resolution (logMAR) in the 3+PRN group, while it was 0.72±0.46 logMAR in the 1+PRN group. Final BCVA was 0.42±0.55 logMAR in the 3+PRN group and 0.38±0.50 logMAR in the 1+PRN group (P=0.979). Additionally, the BCVA changes from baseline to final visit were not significantly different (-0.50±0.45 logMAR in the 3+PRN group, and -0.33±0.39 logMAR in the 1+PRN group; P=0.255). CONCLUSION: No significant differences in the anatomical or functional results are found between 3+PRN and 1+PRN regimens in the patients receiving ranibizumab for ME secondary to BRVO. Intact IS/OS and baseline BCVA are good predictor of the visual gain, while baseline CMT is a good predictor of the anatomical gain

Effects of dexamethasone treatment on serous retinal detachment in ranibizumab-resistant diabetic macular edema

Purpose: To evaluate outcome of intravitreal dexamethasone implant (IDI) treatment on serous retinal detachment (SRD) in patients with ranibizumab-resistant diabetic macular edema (DME).Materials and methods: Forty-eight eyes of 48 patients with DME resistant to ranibizumab were enrolled in this retrospective and comparative study. Patients were divided into two groups according to presence of serous retinal detachment: (1) SRD or (2) non-SRD groups. All patients had at least three monthly ranibizumab injections, after which they were treated with IDI. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), use of antiglaucomatous drugs, and presence of cataract progression were noted at 1, 3, and 6 months post-IDI treatment.Results: There was not any statistically significant difference in terms of baseline characteristics of the patients. The mean CRT was declined in both groups at 1, 3, and 6 months (p < 0.001). After IDI treatment, the mean BCVA was improved in both groups at 1, 3, and 6 months (p < 0.001). When groups were compared, the change in CRT was higher in the SRD group (p = 0.018), while there was no statistically significant difference between groups in terms of BCVA changes (p = 0.448).Conclusion: The presence of SRD resulted in higher anatomical gain. SRD had no effects on visual changes after dexamethasone treatment in patients with ranibizumab-resistant DME

The corneal effects of intravitreal dexamethasone implantation

Objectives: To evaluate the corneal effects of the intravitreal dexamethasone implantation using corneal topography and specular microscopy.Material and methods: 27 eyes of the 27 patients who received a single intravitreal dexamethasone implantation dose for diabetic macular edema were enrolled in this study. Sirius topography and EM-3000 specular microscopic examinations were performed at the initial examination (baseline), and then on the first day, during the first week, and 1 month after IDI. Changes in corneal parameters were investigated.Results: The mean age was 58.66 +/- 6.59 years. 15 patients were men, and 12 were women. The mean disease duration was 12.2 +/- 2.4 months, and mean glycosylated hemoglobin (HbA1c) was 7.2 +/- 1.1. After dexamethasone injection, the mean central corneal thickness, endothelial cell density, and coefficient variation of cell area presented a statistically significant decrease (p 0.05).Conclusion: Intravitreal dexamethasone implantation affects corneal endothelial cell structure but does not appear to affect corneal topography parameters

Factors affecting the efficacy of treatment and recurrence in intravitreal ranibizumab applications in neovascular age-related macular degeneration

Objective: To evaluate the efficacy of intravitreal ranibizumab treatment and factors affecting the treatment in neovascular type age-related macular degeneration Methods: Ranibizumab injected 60 eyes of 60 patients with the diagnosis of neovascular age-related macular degeneration in our clinic were analyzed retrospectively. After three consecutive 3-month follow-up dose injection, decision to perform re-injections was according to best corrected visual acuity, fundus fluorescein angiography and optical coherence tomography findings in consecutive month follow-up. Patients were evaluated in terms of number of ranibizumab injections, pre-treatment and follow-up best-corrected visual acuity, central macular thickness, factors affecting the treatment and recurrence. Results: 30 (50%) of patients were male and 30 (50%) were women with a mean age of 67 ± 9.14 (50-84). While pre-treatment visual acuity average of the cases was 1.12 ± 0.69 logMAR, at the end of 12th month was 0.92 ± 0.63 logMAR. While pre-treatment mean central macular thickness was 343.1 ± 97 µm, in the 12th month was 286 ± 75.5 µm. While the first 3 injections were enough in 20 (33.3%) eyes, but 40 (66.7%) eyes had to be re-injected. Average number of injections was 4.23 ± 1.21. While there was no significant correlation between recent functional and anatomical success with age, gender, type of lens and membrane type, more vision gain was obtained in patients with initial lower visual acuity. The age of patients, pre-treatment visual acuity, membrane type were found to have no significant effect on recurrence rate. Membranes with classic component required more injection than occult type. Conclusion: After intravitreal injection of ranibizumab which is safe and effective in neovascular type of age-related macular degeneration more vision gain was obtained in patients with initial lower visual acuity and presence of classic component initial higher visual acuity, lower age required more injection

Retinal vascular caliber in Turkish adolescents with type 1 diabetes mellitus

Diabetic retinopathy (DR) is a common result of diabetes mellitus (DM). Alterations in retinal vascular caliber may be early finding of diabetic retinopathy. The aim of this study is to demonstrate retinal vascular caliber changes in Turkish adolescents with type 1 diabetes mellitus (T1D). This prospective and cross-sectional study included 108 eyes of the T1D adolescents and 75 eyes of the age-sex matched control group. Fundus images of the both groups were taken with fundus camera system (FA; Visucam500; Carl Zeiss Meditec, Jena, Germany) and were analyzed with IVAN which is a semi-automated system used to measure the width of retinal vessels using a digital retinal image (Nicole J. Ferrier, College of Engineering, Fundus Photography Reading Center, University of Wisconsin, Madison, WI, USA). Central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE) and artery-vein ratio (AVR) were compared between groups. Both groups were comparable in baseline characteristics (p>0.05). The mean CRAE value was higher in T1D group (179.03±29.58 μ in T1D group and 166.64±15.76 μ in control group, p<0.001). The mean AVR value was higher in T1D group, too (0.97±0.46 in T1D and 0.84±0.19 in control group, p=0.01). There was no statistically significant difference in CRVE value between groups. CRAE was found to be higher in T1D patients. This arteriolar dilation may be the early finding of diabetic retinopathy

Pars Plana Vitrectomy and Heavy Silicon oil Tamponade for Inferior Retinal Detachment

Pur po se: To evaluate the effectiveness and safety of pars plan vitrectomy and heavy silicone oil tamponade in eyes with inferior retinal detachment. Ma te ri al and Met hod: Eighteen eyes that underwent pars plana vitrectomy and heavy silicone oil (Densiron) tamponade were evaluated retrospectively. Twenty-gauge vitrectomy was performed and heavy silicon oil was introduced at the conclusion of the surgery. Patients were examined postoperatively at 1 day, 1 week, and monthly intervals. Silicon was removed in suitable eyes during the study period. Best-corrected visual acuity, ocular tension measurements, and biomicroscopic examinations were performed. Final visual and anatomic results were recorded. Re sults: The median age of the patients was 43 (range: 16-67) years. Associate ocular pathology to the inferior detachments were dropped nucleus (n=2), complicated uveitis (n=1), degenerative myopia (n=2), penetrating trauma (n=2), and blunt ocular trauma (n=3). Eight (44%) eyes had previous unsuccessful detachment surgery. Anatomic success was achieved in 16 (88%) eyes at a mean of 11.76 months (range: 5- 21) of follow-up. Visual acuity was improved in 4 eyes, stabilized in 12 eyes, and worsened in 2 eyes. Postoperative hypotony developed in one eye, and oil emulsification developed in 2 eyes. Dis cus si on: Use of heavy silicone oil (Densiron) tamponade is effective and safe in eyes with inferior retinal detachment. (Turk J Ophthalmol 2012; 42: 458-61

Comparison of the effects of aflibercept and dexamethasone in central retinal vein occlusion with serous retinal detachment

Background: The aim of this study is to compare the efficacy of intravitreal aflibercept and dexamethasone implantation injections in central retinal vein occlusion accompanied by serous retinal detachment. Methods: Sixty-eight eyes of 68 patients with treatment-naive macular oedema post-central retinal vein occlusion were enrolled in the retrospectively designed study. All of the patients had serous retinal detachment at baseline. The patients received three intravitreal aflibercept injections with an interval of four weeks and followed by pro re nata treatment protocol (intravitreal aflibercept group, n = 37) or a single dose dexamethasone implantation injection (dexamethasone implantation group, n = 31). Best-corrected visual acuity, central retinal thickness and the height of serous retinal detachment parameters were compared at baseline, and in the first, second, third and sixth months. Results: The groups were similar in terms of baseline characteristics (p > 0.05 for all). The visual gain was greater in the intravitreal aflibercept group (p = 0.013). While the intravitreal aflibercept group had a significant central retinal thickness decrease in the first and sixth months (p = 0.011 and p = 0.001, respectively), this superiority was not observed during the entire follow-up period (p = 0.212). There was no difference in serous retinal detachment resolution between the groups (p = 0.403). Two patients in the intravitreal aflibercept group (5.4%) and five patients in the dexamethasone implantation group (16.1%) had serous retinal detachment at the final visit (p = 0.158). Conclusion: Both intravitreal aflibercept and dexamethasone implantation injections seemed to be effective in the treatment of central retinal vein occlusion with serous retinal detachment. Intravitreal aflibercept treatment yielded better results in terms of visual gain and showed a faster anatomical response

Management of hypotony and flat anterior chamber associated with glaucoma filtration surgery

<b>AIM:</b>To determine the effectiveness of pharmacological and interventional treatment of hypotony and flat anterior chamber (FAC) resulting from glaucoma filtration surgery.<b>METHODS:</b>We retrospectively examined the medical records of fifty-two trabeculectomy patients (52 eyes) who developed postoperative hypotony and FAC. The management and associated complications of hypotony, changing intraocular pressure (IOP) and best corrected visual acuity (BCVA) were evaluated.<b>RESULT:</b>Of the 52 patients with hypotony, 29 (56%) had a grade 1 FAC, 21 (40%) had a grade 2 FAC, and only 2 had a grade 3 FAC. There was no significant difference between the mean preoperative IOP and the mean IOP at three and six months after surgery. Thirteen eyes (25%) required antiglaucomatous medication three months after surgery. The mean BCVA at 6mo after surgery was significantly reduced as compared with the mean preoperative BCVA.<b>CONCLUSION:</b>Hypotonia and FAC following trabeculectomy are associated with troublesome complications that require pharmacological and/or surgical treatment. Thus, close follow-up is essential for affected patients

Clinical Features of Patients with Post-Traumatic Canalicular Laceration and the Effectiveness of Surgical Repair with Monoka Tube Intubation

Objectives: Evaluation of the clinical characteristics of patients with post-traumatic canalicular laceration and the results of surgical repair of these patients with Monoka® tube intubation. Materials and Methods: Medical records of 15 patients who underwent surgical repair with Monoka® tube implantation due to canalicular laceration in our clinic between 2009 and 2013 years were analyzed retrospectively. Patients were analyzed in terms of their demographic characteristics, leading cause of injury, accompanying ocular injuries along with anatomical and functional success. Results: The mean age was 25 (1-56) years. Twelve patients (80%) were males and 3 (20%) were female. Twelve (80%) eyes presented with lower canalicular laceration, 1 (6.7%) eye-with upper canalicular laceration, and 2 (13.3%) eyes had bicanalicular laceration. Five of injuries (33%) were due direct sharp objects and 10 of injuries (66%) occurred due to blunt trauma. Six of patients were operated under general anesthesia and 9 of patients were operated under local anesthesia. The mean time duration between canalicular injury and surgery was found to be 14 hours (4-39 hours). The mean duration of the tubes’ residence time was 5.26 months (1-6 months). Patients were followed averagely 14 months (6-32 months) in the postoperative period. The open status of lavage was considered as anatomical success, and the absence of fluorescein dye pooling and epiphora was considered as functional success. Except for 1 patient with tube protrusion in the early postoperative first month, anatomical and functional success was achieved in 14 patients (93.3%) during the follow-up period. Conclusion: After traumatic canalicular lacerations, Monoka® tube intubation is an easily applicable and effective method with low risk of damage. (Turk J Ophthalmol 2015; 45: 14-17

Comparison of the effect of ranibizumab and dexamethasone implant in diabetic macular edema with concurrent epiretinal membrane

Objective. - To compare the efficacy and safety of intravitreal ranibizumab (RZB) injections and intravitreal dexamethasone (DEX) implant in diabetic macular edema (DME) with concurrent epiretinal membrane (ERM). Methods. - This was a retrospective, observational, comparative study. Medical records of DME patients with concurrent ERM were retrospectively reviewed. Seventeen eyes of 16 patients treated with 3 consecutive monthly RZB injections (RZB group) and 22 eyes of 18 patients treated with a DEX implant (DEX group) were included. The groups were compared at baseline, 1st, 2nd, 3rd and 4th months in terms of best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP). Results. - Eighteen of the 39 eyes (46.1%) were phakic at baseline, 9 (52.9%) of which were treated with RZB, whereas 9 (40.9%) were treated with DEX implant (P = 0.528). Although CMT improved significantly in both the RZB and DEX groups (P<0.001); the trend was different (P=0.003). The mean change in CMT at 1 month in the DEX group was greater (DEX: 188.2 +/- 142.7 mu m; RZB: 95.7 +/- 110.7 mu m; P=0.034); it was in favor of RZB group at the 3rd and 4th months (DEX: -52.7 +/- 86.9 mu m; RZB: 1.4 +/- 31.4 mu m; P=0.012. DEX: -63 +/- 67.3 mu m; RZB: -5.8 +/- 43.9 mu m; P=0.004, respectively). BCVA improved significantly in both groups (P < 0.001). There was no statistical difference between the groups with regard to gain in BCVA or IOP change throughout the study period (P=0.572, P=0.064, respectively). Conclusion. - Both RZB and DEX are effective in improving anatomical and visual outcomes in DME with concurrent ERM. The DEX group was associated with a prompt anatomic response, but with a gradual decrease from 3rd month